Extended Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: Risks vs. Benefits

Current practice guidelines recommend extended venous thromboembolism (VTE) prophylaxis in high-risk surgical patients, but its value is less clear in acutely ill medical patients. Extended dosing, with enoxaparin in the EXCLAIM trial (JW Hosp Med Aug 30 2010) and with rivaroxaban in the MAGELLAN trial, has been associated with lower rates of VTE than a shorter treatment course — but at the cost of a higher risk for bleeding.

Researchers now report on 4495 patients (mean age, 67) in the international ADOPT trial: a randomized, double-blind, placebo-controlled comparison of extended-dose oral apixaban (2.5 mg, twice daily, for 30 days) with a shorter course of subcutaneous enoxaparin (40 mg, once daily, for 6–14 days). Nearly all patients wer…