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Anas Ibraheem: Clearing the Long-Standing Debate on Bleeding Risk in VTE Anticoagulation
Abdulrahman Nasiri/LinkedIn; Anas Ibraheem/www.researchgate.net
Apr 1, 2026, 13:48

Anas Ibraheem: Clearing the Long-Standing Debate on Bleeding Risk in VTE Anticoagulation

Anas Ibraheem, Medical Oncology Fellow at The London Clinic, shared  Abdulrahman Nasiri‘s post on LinkedIn:

“A recent gem from NEJM, COBRRA trial: an international trial with a prospective, randomised, open-label, and blinded end-point design clear the long-standing debate of apixaban vs rivaroxaban (head-to-head) bleeding risk when a decision to start anticoagulants for acute VTE is taken.

A wonderful illustration of those results in the attached post. ”

Abdulrahman Nasiri, Assistant Professor of Medicine and Hematology at Imam Mohammad Ibn Saud Islamic University, shared a post on LinkedIn:

“In preparation for my upcoming Grand Rounds presentation, I’ve put together these slides translating the recent COBRRA trial (NEJM 2026) titled:

‘Settling the DOAC Debate in Acute VTE’

For years, major clinical guidelines haven’t recommended one DOAC over another due to a lack of head-to-head randomized trials.

Here is the most important concepts and the clinical shift this trial brings to our practice:

  • Identical Efficacy: Both apixaban and rivaroxaban demonstrated an identical approximately one percent rate of recurrent VTE.
  • Superior Safety: Apixaban cut the risk of clinically relevant bleeding by more than half and drove an 84 percent reduction in major bleeding.
  • The Dosing Hypothesis: Why the difference? The bleeding divergence explodes in the first 3 weeks.

Rivaroxaban requires a high-dose induction phase that is three times longer than apixaban (twenty-one days versus seven days).

I am sharing the presentation here, please feel free to use and adapt these slides for your own reference, clinical discussions, or teaching! ”

Anas Ibraheem: Clearing the Long-Standing Debate on Bleeding Risk in VTE Anticoagulation
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Abdulrahman Nasiri Anas Ibraheem Apixaban Health Hematology Hemophilia Hemostasis Hemostasis News Hemostasis Today Medicine NEJM Rivaroxaban
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