HI-PRO: Apixaban for Extended Treatment of Provoked Venous Thromboembolism
Description
On this episode, Pip and Rich discuss Piazza et al. Apixaban for Extended Treatment of Provoked Venous Thromboembolism, published in the New England Journal of Medicine in August 2025. This trial randomised 600 patients with VTE provoked by a transient risk factor but who also had at least one enduring risk factor, after completing 3 months of anticoagulation, to receive either apixaban 2.5 mg twice daily or placebo for 12 months. Extended apixaban reduced recurrent VTE from 10.0% to 1.3% (HR 0.13, 95% CI 0.04–0.36) with very low rates of major bleeding, though clinically relevant non-major bleeding was more frequent.
The caveat to these findings is the definition of "provoked" used in the trial, which is wide-ranging. This is an insightful discussion and is highly relevant to clinical practice.
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