Shortened apixaban lead-in therapy ups bleeding rates in patients treated for VTE

Patients treated with shortened lead-in apixaban for venous thromboembolism (VTE) show increased bleeding events, and those with bleeding risk factors appear to gain no benefit from taking apixaban 10 mg twice daily, according to a study.

Adult patients admitted to the Veterans Affairs Health Care System from January 2011 to April 2022, who received at least 24 hr of parenteral anticoagulation followed by lead-in apixaban therapy for VTE, were included in this retrospective cohort study.

The research team assessed bleeding among patients treated with shortened lead-in apixaban (study group) compared with the standard 7-day duration (control group).

Of the patients, 65 were included in the study group and 78 in the control group. The majority of participants were treated for pulmonary embolism (72 percent) and received initial treatment with enoxaparin (71 percent).

The study group had a longer duration of parenteral anticoagulation (3.6 vs 2.5 days; p<0.01) and shorter length of apixaban lead-in therapy (4.1 vs 7 days; p<0.01) than the control group. 

Furthermore, bleeding rates were significantly higher in the study group (18.5 percent vs 5.1 percent; p=0.02) relative to the control group, with no difference in VTE recurrence. The predictors of bleeding included P2Y12 and P-gp inhibitor use, as well as increased creatinine and age.

“Larger studies are needed where apixaban lead-in therapy is omitted following parenteral anticoagulation in patients with bleeding risk factors,” the researchers said.