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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism.

Lana A Castellucci1, Vivien M Chen2,3,4, Michael J Kovacs5

  • 1Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa.

The New England Journal of Medicine
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Summary
This summary is machine-generated.

Apixaban significantly reduced bleeding risk compared to rivaroxaban in acute venous thromboembolism patients. This 3-month trial found apixaban to be a safer oral anticoagulant option, lowering clinically relevant bleeding events.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Apixaban and rivaroxaban are leading oral anticoagulants for acute venous thromboembolism (VTE).
  • Clinical data comparing the bleeding risk between apixaban and rivaroxaban in VTE patients remains limited.
  • Understanding differential bleeding profiles is crucial for optimizing VTE treatment strategies.

Purpose of the Study:

  • To directly compare the incidence of clinically relevant bleeding between apixaban and rivaroxaban in patients with acute VTE.
  • To evaluate secondary outcomes, including all-cause mortality, in patients treated with either anticoagulant.

Main Methods:

  • An international, prospective, randomized, open-label, blinded end-point trial involving 2760 patients with acute pulmonary embolism or deep-vein thrombosis.
  • Patients received either apixaban (10 mg twice daily for 7 days, then 5 mg twice daily) or rivaroxaban (15 mg twice daily for 21 days, then 20 mg daily) for 3 months.
  • The primary endpoint was a composite of major or clinically relevant nonmajor bleeding, assessed using International Society on Thrombosis and Haemostasis criteria.

Main Results:

  • A primary outcome event occurred in 3.3% of the apixaban group versus 7.1% of the rivaroxaban group (Relative Risk: 0.46; 95% CI, 0.33-0.65; P<0.001).
  • All-cause mortality was low in both groups (0.1% for apixaban vs. 0.3% for rivaroxaban).
  • Serious adverse events unrelated to bleeding or thrombosis were comparable between groups.

Conclusions:

  • Apixaban demonstrated a significantly lower risk of clinically relevant bleeding compared to rivaroxaban in patients treated for acute venous thromboembolism over a 3-month period.
  • The findings suggest apixaban may offer a superior safety profile regarding bleeding complications in this patient population.
  • Further research may explore long-term outcomes and specific patient subgroups.