Apixaban not better than enoxaparin for VTE prevention
An extended course of thromboprophylaxis with apixaban does not give better results than a shorter course with enoxaparin, according to a study published in the New England Journal of Medicine (2011;365:2167).
The ADOPT trial sought to determine the potential of apixaban to prevent venous thromboembolism (VTE) in acutely ill medical patients during hospital stays and in the extended period after their discharge (see Panel).
Researchers found that, over 30 days from the start of treatment, major bleeding events were more common in patients treated with apixaban (0.47 per cent) than those treated with enoxaparin (0.19 per cent) (relative risk 2.58; 95 per cent confidence interval, 1.02–7.24, P=0.04).
At day 30, death related to VTE had occurred in 2.71 per cent of patients receiving apixaban compared with 3.06 per cent of patients receiving enoxaparin (relative risk 0.87, CI 0.62–1.23, P=0.44).
The authors conclude that the results of the trial do not provide evidence for a policy of extended apixaban thromboprophylaxis in a broad population of patients after hospital discharge. However, more precise risk-stratification methods are needed to identify a narrower spectrum of patients who may benefit from extended prophylaxis.
The study was supported by Bristol-Myers Squibb and Pfizer, the marketing authorisation holders of apixaban.
A total of 6,528 patients who were admitted to hospital following congestive heart failure, acute respiratory failure, acute rheumatic disorder or inflammatory bowel disease were randomly assigned to receive apixaban 2.5mg, administered orally twice-daily for 30 days, or enoxaparin 40mg, administered subcutaneously once-daily during their stay in hospital, for a minimum of six days.
Citation: The Pharmaceutical Journal URI: 11090956
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