Extended Use of Blood Thinners Significantly Reduces VTE Recurrence in Patients with Enduring Risk Factors

A recent study presented at ESC Congress 2025 and published in the New England Journal of Medicine has shown that prolonged treatment with apixaban, at a dosage of 2.5 mg twice daily, can notably lower the risk of recurrent venous thromboembolism (VTE) in patients who have experienced provoked VTE and possess persistent risk factors. The research highlights that extending anticoagulation therapy beyond the initial treatment period offers substantial benefits with minimal safety concerns.

Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, can result from temporary factors such as surgery or injury or from chronic health conditions like obesity or autoimmune diseases. Standard practice often involves short-term anticoagulation, but for some patients with ongoing risk factors, the best duration of such therapy remains uncertain.

The randomized, double-blind HI-PRO trial, led by Dr. Gregory Piazza from Brigham and Women’s Hospital, involved 600 participants who had recently experienced a provoked VTE event and had completed at least three months of standard anticoagulation. Patients were assigned to receive either apixaban or placebo for 12 months. The primary goal was to reduce symptomatic recurrent VTE, while safety was assessed through major bleeding incidents.

Results demonstrated a considerable reduction in recurrence rates among those treated with apixaban, with only 1.3% experiencing recurrent VTE compared to 10.0% in the placebo group, representing an 87% risk reduction. Major bleeding was rare, occurring in just one patient in the apixaban group, and there were no deaths related to bleeding. Minor bleeding events were slightly higher with apixaban but remained manageable.

These findings suggest that extended low-dose apixaban therapy is effective and safe for patients with provoked VTE who have ongoing risk factors. The study emphasizes the need for personalized treatment strategies and further research to determine which patient subgroups benefit the most from long-term anticoagulation.

As Dr. Piazza concluded, “Low-intensity apixaban for 12 months significantly reduces VTE recurrence with minimal safety concerns in this patient population.” This breakthrough offers promising options for improving long-term management of VTE in high-risk groups.