Apixaban vs rivaroxaban for acute VTE: Insights from 1st head-to-head randomised trial

Direct oral anticoagulants (DOACs) are established as first-line therapy for acute venous thromboembolism (VTE), offering effective thromboprophylaxis with improved safety compared with vitamin K antagonists. [Blood Adv 2020;4693-4738] However, despite the widespread use of apixaban and rivaroxaban in clinical practice, a lack of direct randomised comparative evidence has historically limited clinicians’ ability to differentiate between these agents. The COBRRA trial fills this gap, representing the first head-to-head randomised controlled trial (RCT) comparing apixaban and rivaroxaban in patients with acute VTE. [N Engl J Med 2026;394:1051-1060]