Pulmonary embolism · Extended anticoagulation
Apixaban for Extended Treatment of Provoked Venous Thromboembolism
| Design | Phase 4 randomised controlled trial |
|---|---|
| Treatment | Low-intensity apixaban for 12 months |
| Control | Placebo |
| Population | 600 patients with provoked venous thromboembolism and enduring risk factors, mean age 59.5, 57.0% female |
| Follow-up | 12 months |
| Primary endpoint | Symptomatic recurrent venous thromboembolism |
| Result | Symptomatic recurrent venous thromboembolism occurred in 4 of 300 (1.3%) on apixaban, substantially fewer than on placebo, with a low risk of major bleeding. |
| Secondary endpoints | Major bleeding, clinically relevant non-major bleeding, all-cause mortality |
Among patients with provoked VTE and enduring risk factors, low-intensity therapy with apixaban for 12 months resulted in a lower risk of symptomatic recurrent VTE than placebo, with a low risk of major bleeding.
The trial authors, in the published abstract
Attacks the assumption that a provoked clot needs only a short course. Where the provoking factor has not gone away, extended low-intensity treatment prevents recurrence cheaply and safely. Complements RENOVE, which asked the dose question in patients already on indefinite treatment.
Piazza G, Bikdeli B, Pandey AK, et al. Apixaban for Extended Treatment of Provoked Venous Thromboembolism. N Engl J Med 2025 Sep 25;393(12):1166-1176.