Is There a Role for Betrixaban to Prevent Stroke in Medically Ill Patients?
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Article, see p 648
Pharmacological thromboprophylaxis given for up to 14 days reduces the risk of venous thromboembolism in hospitalized medical patients.1 Because the risk of thromboembolism remains elevated for at least several weeks after an acute medical illness, randomized trials have evaluated the role of extending prophylaxis for up to 1 month. Their results indicate that extended thromboprophylaxis with enoxaparin, apixaban, or rivaroxaban reduces the risk of venous thromboembolism but results in more bleeding and does not produce a net benefit.2–4 Based on these data, current guidelines do not recommend extending thromboprophylaxis beyond the period of patient immobilization or acute hospital stay.5
APEX (Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban) is the latest trial6 to evaluate extended thromboprophylaxis in acutely ill medical patients. In total, 7513 patients (mean age, 76 years) who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (20 or 40 mg once daily) for 6 to 14 days or the nonvitamin K antagonist oral anticoagulant (NOAC), betrixaban (40 or 80 mg once daily), for 35 to 42 days6: 11% of patients were hospitalized with an acute ischemic stroke and 45% with acute heart failure,6 a known risk factor for stroke7; …