Apixaban was the safest anticoagulant used for extended treatment of venous thromboembolism (VTE), according to a network meta-analysis of more than 11.000 patients.
While several anticoagulants significantly reduced the risk of VTE recurrence compared to placebo, only apixaban also did not increase bleeding risk significantly more than placebo. In fact, all active therapies except aspirin increased the risk of composite bleeding by 2-4 times compared to apixaban (2.5 mg), according to Diana M. Sobieraj, Pharm.D., of the University of Connecticut, and her colleagues.
In addition to apixaban (2.5 mg and 5 mg), the other anticoagulants that significantly reduced the risk of VTE recurrence compared to placebo were dabigatran, rivaroxaban, idraparinux, and vitamin K antagonists (VKAs). Of these drugs, idraparinux was least effective and VKAs were most effective at reducing the risk of a recurring VTE,
All of the anticoagulants other than idraparinux significantly reduced VTE risk more than aspirin did, ranging from a 73% reduction, with either apixaban (2.5 mg) or rivaroxaban, to an 80% reduced risk with VKAs.
Whether anticoagulation therapy should be extended for patients with VTE beyond 3 months remains a topic of debate, but results of the analysis “provide additional justification for” doing so, “primarily in patients with unprovoked proximal [VTE] with low to moderate bleeding risk,” the researchers reported.
Find the full study in Thrombosis Research (doi.org/10.1016/j.thromres.2015.02.032)