Benjamin P. Geisler
@ben-geisler.com
Stipendiat in Oslo, 🇳🇴 | prior hospitalist | Stuck between 3 continents/still fresh off the boat | RT≠opinion≠others'
Bottom Line: Extended low-dose apixaban significantly reduces recurrent VTE in patients with provoked VTE + enduring risk factors, with low major bleeding risk. This will likely change practice and guidelines.
www.nejm.org/doi/ful...
8/8
www.nejm.org/doi/ful...
8/8
Apixaban for Extended Treatment of Provoked Venous Thromboembolism | NEJM
The appropriate duration of anticoagulation for venous thromboembolism (VTE) in patients
who have a transient provoking factor (e.g., surgery, trauma, or immobility) and concomitant
enduring risk f...
www.nejm.org
September 9, 2025 at 11:21 AM
Bottom Line: Extended low-dose apixaban significantly reduces recurrent VTE in patients with provoked VTE + enduring risk factors, with low major bleeding risk. This will likely change practice and guidelines.
www.nejm.org/doi/ful...
8/8
www.nejm.org/doi/ful...
8/8
Clinical Implications: The 10% recurrence rate in placebo group suggests "provoked" VTE with enduring risk factors may have similar recurrence risk to "unprovoked" VTE. Simple provoked vs unprovoked categorization may be insufficient for treatment decisions.
7/8
7/8
September 9, 2025 at 11:21 AM
Clinical Implications: The 10% recurrence rate in placebo group suggests "provoked" VTE with enduring risk factors may have similar recurrence risk to "unprovoked" VTE. Simple provoked vs unprovoked categorization may be insufficient for treatment decisions.
7/8
7/8
Study Population: Mean age 59.5 years, 57% female. Most common provoking factors: surgery (33.5%), immobility (31.3%), trauma (19.2%). Most common enduring risk factors: chronic inflammatory disease (52.2%), obesity BMI≥30 (48.2%), atherosclerotic CVD (29.3%).
6/8
6/8
September 9, 2025 at 11:21 AM
Study Population: Mean age 59.5 years, 57% female. Most common provoking factors: surgery (33.5%), immobility (31.3%), trauma (19.2%). Most common enduring risk factors: chronic inflammatory disease (52.2%), obesity BMI≥30 (48.2%), atherosclerotic CVD (29.3%).
6/8
6/8
Safety Events: Major bleeding: 0.3% (apixaban) vs 0% (placebo). Clinically relevant non-major bleeding: 4.8% vs 1.7% (HR 2.68, P=0.06). One major bleed was a 3mm subdural hematoma after horse fall - no hospitalization required.
5/8
5/8
September 9, 2025 at 11:21 AM
Safety Events: Major bleeding: 0.3% (apixaban) vs 0% (placebo). Clinically relevant non-major bleeding: 4.8% vs 1.7% (HR 2.68, P=0.06). One major bleed was a 3mm subdural hematoma after horse fall - no hospitalization required.
5/8
5/8
Primary Results: Symptomatic recurrent VTE occurred in 1.3% (apixaban) vs 10.0% (placebo)
- an 87% relative risk reduction (HR 0.13, 95% CI 0.04-0.36, p<0.001)
Number needed to treat = 12
4/8
- an 87% relative risk reduction (HR 0.13, 95% CI 0.04-0.36, p<0.001)
Number needed to treat = 12
4/8
September 9, 2025 at 11:21 AM
Primary Results: Symptomatic recurrent VTE occurred in 1.3% (apixaban) vs 10.0% (placebo)
- an 87% relative risk reduction (HR 0.13, 95% CI 0.04-0.36, p<0.001)
Number needed to treat = 12
4/8
- an 87% relative risk reduction (HR 0.13, 95% CI 0.04-0.36, p<0.001)
Number needed to treat = 12
4/8
Study Design: HI-PRO was a randomized, double-blind, placebo-controlled trial.
600 patients with provoked VTE + ≥1 enduring risk factor received apixaban 2.5mg BID vs. placebo for 12 months after completing ≥3 months of initial anticoagulation.
3/8
600 patients with provoked VTE + ≥1 enduring risk factor received apixaban 2.5mg BID vs. placebo for 12 months after completing ≥3 months of initial anticoagulation.
3/8
September 9, 2025 at 11:21 AM
Study Design: HI-PRO was a randomized, double-blind, placebo-controlled trial.
600 patients with provoked VTE + ≥1 enduring risk factor received apixaban 2.5mg BID vs. placebo for 12 months after completing ≥3 months of initial anticoagulation.
3/8
600 patients with provoked VTE + ≥1 enduring risk factor received apixaban 2.5mg BID vs. placebo for 12 months after completing ≥3 months of initial anticoagulation.
3/8
Background: Current guidelines recommend 3-6 months of anticoagulation for provoked VTE (surgery, trauma, immobility).
What about patients with enduring risk factors like obesity, chronic lung disease, or autoimmune disorders?
2/8
What about patients with enduring risk factors like obesity, chronic lung disease, or autoimmune disorders?
2/8
September 9, 2025 at 11:21 AM
Background: Current guidelines recommend 3-6 months of anticoagulation for provoked VTE (surgery, trauma, immobility).
What about patients with enduring risk factors like obesity, chronic lung disease, or autoimmune disorders?
2/8
What about patients with enduring risk factors like obesity, chronic lung disease, or autoimmune disorders?
2/8
6/7
🔍 Learn more about the projections (incl. brilliant viz) directly from the Guardian article:
www.theguardian.com/...
Thoughts?
🔍 Learn more about the projections (incl. brilliant viz) directly from the Guardian article:
www.theguardian.com/...
Thoughts?
Europe’s population crisis: see how your country compares – visualised
How anti-immigration politics across the EU clashes with demographic reality
www.theguardian.com
September 4, 2025 at 4:28 PM
6/7
🔍 Learn more about the projections (incl. brilliant viz) directly from the Guardian article:
www.theguardian.com/...
Thoughts?
🔍 Learn more about the projections (incl. brilliant viz) directly from the Guardian article:
www.theguardian.com/...
Thoughts?
5/6
⚖️ Migration is one factor shaping Europe’s future. Employment rates, pension reform & healthcare capacity also matter. Some rural areas face depopulation, but newcomer resettlement projects show potential to revitalize communities.
⚖️ Migration is one factor shaping Europe’s future. Employment rates, pension reform & healthcare capacity also matter. Some rural areas face depopulation, but newcomer resettlement projects show potential to revitalize communities.
September 4, 2025 at 4:28 PM
5/6
⚖️ Migration is one factor shaping Europe’s future. Employment rates, pension reform & healthcare capacity also matter. Some rural areas face depopulation, but newcomer resettlement projects show potential to revitalize communities.
⚖️ Migration is one factor shaping Europe’s future. Employment rates, pension reform & healthcare capacity also matter. Some rural areas face depopulation, but newcomer resettlement projects show potential to revitalize communities.
4/6
🏥 European health systems depend heavily on foreign-trained doctors. Norway, Ireland, Switzerland, UK & Sweden have 30-44% foreign-trained doctors.
🇳🇴 relies on Norwegians educated abroad due to limited domestic medical school slots.
🏥 European health systems depend heavily on foreign-trained doctors. Norway, Ireland, Switzerland, UK & Sweden have 30-44% foreign-trained doctors.
🇳🇴 relies on Norwegians educated abroad due to limited domestic medical school slots.
September 4, 2025 at 4:28 PM
4/6
🏥 European health systems depend heavily on foreign-trained doctors. Norway, Ireland, Switzerland, UK & Sweden have 30-44% foreign-trained doctors.
🇳🇴 relies on Norwegians educated abroad due to limited domestic medical school slots.
🏥 European health systems depend heavily on foreign-trained doctors. Norway, Ireland, Switzerland, UK & Sweden have 30-44% foreign-trained doctors.
🇳🇴 relies on Norwegians educated abroad due to limited domestic medical school slots.
3/6
💸 Tax burdens are rising as pension & elderly care costs grow. These demographic trends will put greater fiscal pressure on governments & societies in decades ahead.
💸 Tax burdens are rising as pension & elderly care costs grow. These demographic trends will put greater fiscal pressure on governments & societies in decades ahead.
September 4, 2025 at 4:28 PM
3/6
💸 Tax burdens are rising as pension & elderly care costs grow. These demographic trends will put greater fiscal pressure on governments & societies in decades ahead.
💸 Tax burdens are rising as pension & elderly care costs grow. These demographic trends will put greater fiscal pressure on governments & societies in decades ahead.