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Bartosz Hudzik: Choosing The Right Anticoagulant for Acute Venous Thromboembolism

Bartosz Hudzik/LinkedIn

Mar 16, 2026, 18:59

Bartosz Hudzik: Choosing The Right Anticoagulant for Acute Venous Thromboembolism

Bartosz Hudzik, Associate Profesor at Medical University of Silesia, shared a post on LinkedIn about a recent article by Lana A. Castellucci et al, adding:

”Choosing the right anticoagulant for acute venous thromboembolism (VTE) often comes down to balancing efficacy with bleeding risk.

A recent international randomized trial compared apixaban and rivaroxaban, two of the most commonly used direct oral anticoagulants for treating acute pulmonary embolism and proximal deep-vein thrombosis.

Study design

2,760 patients with acute symptomatic VTE
Randomized 1:1 to apixaban or rivaroxaban
3-month treatment period
Primary endpoint: clinically relevant bleeding (major plus clinically relevant non-major bleeding)

Dosing

Apixaban: 10 mg BID for 7 days – 5 mg BID
Rivaroxaban: 15 mg BID for 21 days – 20 mg daily

Key results

Clinically relevant bleeding:

Apixaban: 3.3%
Rivaroxaban: 7.1%
Relative risk: 0.46 (95% CI 0.33–0.65, P < 0.001)

This represents ~54% lower risk of clinically relevant bleeding with apixaban over the 3-month treatment period.

Mortality remained very low in both groups

Apixaban: 0.1%
Rivaroxaban: 0.3%

Takeaway

Among patients with acute VTE, apixaban demonstrated a significantly lower bleeding risk compared with rivaroxaban, while maintaining similar overall safety outcomes.”

Title: Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism

Authors: Lana A. Castellucci, Vivien M. Chen, Michael J. Kovacs, Alejandro Lazo-Langner, Peter Greenstreet, Susan Kahn, Benoit Côté, Sam Schulman, Kerstin de Wit, James Douketis, Deepa Suryanarayan, Tony Wan, Erik Yeo, Genevieve Le Templier, Huyen A. Tran, Abbey Willcox, Helen J. Crowther, Ritam Prasad, Sudeep Shivakumar, Etimbuk Umana, Fionnuala Ni Ainle, Tobias Tritschler, Stefano Barco, Jean-Philippe Galanaud, Marc Blondon, Lisa Baumann Kreuziger, Susan Solymoss, Clive Kearon, Erin Thomas, Tim Ramsay, Gregoire Le Gal, Marc Rodger, for the COBRRA Trial Investigators

Read the Full Article on NEJM

Bartosz Hudzik: Choosing The Right Anticoagulant for Acute Venous Thromboembolism