Yonah S. Tehrani: Providing Clarity for Anticoagulant Selection in Acute Venous Thromboembolism
Yonah S. Tehrani, Physician at Shaare Zedek Medical Center, Jerusalem, shared a post on LinkedIn about a recent article by Lana A. Castellucci et al, published in New England Journal of Medicine:
”Recent head-to-head data from the COBRRA trial (NEJM, March 2026) provides much-needed clarity for anticoagulant selection in acute venous thromboembolism.
In this randomized study of >2,700 patients with symptomatic PE or proximal DVT, apixaban (standard dosing) was associated with a significantly lower rate of clinically relevant bleeding compared with rivaroxaban over 3 months (3.3% vs 7.1%; RR 0.46, p<0.001), with no difference in recurrent VTE.
These findings have direct implications for daily clinical decision-making: when balancing efficacy and safety — particularly in older adults, patients with renal impairment, or those at elevated bleeding risk — apixaban now offers a clear safety advantage without compromising antithrombotic protection.
At the system level, preferential use could translate to reduced bleeding-related hospitalizations, lower transfusion rates, and more confident outpatient PE management.
Important to note the open-label design and potential contribution of dosing regimen differences, but the magnitude of effect is clinically meaningful and should inform local protocols and shared decision-making discussions.
What are your thoughts?
Has this data already shifted prescribing patterns in your institution?
Looking forward to the discussion.”
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
Read the Full Article on New England Journal of Medicine
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