Is Extended-Duration Thromboprophylaxis Effective for the Prevention of Symptomatic VTE in Hospitalized Medical Patients?

A recent meta-analysis of key trials in extended-duration VTE prophylaxis offers new insight into the efficacy and safety of extended-duration VTE prophylaxis in acutely ill medical patientsA new meta-analysis of key trials in extended-duration VTE prophylaxis offers new insight into the efficacy and safety of extended-duration VTE prophylaxis in acutely ill medical patients.

In recent years, enoxaparin, apixaban, rivaroxaban, and betrixaban—a new direct oral anticoagulant specifically indicated for use in hospitalized medical patients—have all undergone randomized controlled trials in the extended duration setting to identify potential advantages over the current standard of care. These assessments included 34,068 acutely ill hospitalized medical patients who received prophylaxis for anywhere from 24 to 47 days.

The results of the meta-analysis suggest a benefit with extended-duration prophylaxis when it does not increase the risk of major bleeding:

  • Extended-duration prophylaxis with apixaban, enoxaparin and rivaroxaban reduced the risk of VTE events at the cost of an increase in major bleeding
  • Betrixaban, however, reduced the risk of VTE events without an increase in major bleeding in the extended duration setting
  • Compared with short-duration prophylaxis, extended duration treatment with betrixaban reduces the risk of symptomatic VTE and non-fatal pulmonary embolism in acutely ill medical patients

This analysis highlights the need for additional research into the efficacy and safety of direct oral anticoagulants in the extended-duration setting.

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