Apixaban for Extended Treatment of Provoked Venous Thromboembolism HI PRO\PADAL TRIAL

Among patients with provoked VTE and enduring risk factors, low-intensity therapy with apixaban for 12 months resulted in a lower risk of symptomatic recurrent VTE than placebo, with a low risk of major bleeding. 

Summary:
1.The trial has a very clear answer: extended treatment with apixaban was effective, with acceptable safety, in this group of patients with provoked VTE with ongoing risk factors.

2.Even though there was no increase in major bleeding, the modest 3% absolute increase in CRNM bleeding is important, especially for those at high bleeding risk.

3.Although the gold standard for large outcome trials is multicenter, single center trials like this one can be informative and we should do more of them.

4.In the context of results other trials of extended VTE treatment for provoked VTE, this trial will change my clinical practice.

Reference:
Piazza G, Bikdeli B, Pandey AK, Krishnathasan D, Khairani CD, Bejjani A, et al. Apixaban for extended treatment of provoked venous thromboembolism. N Engl J Med. 2025 Aug 30;393(12):1166–1176. doi:10.1056/NEJMoa2509426.

For more information:
https://www.nejm.org/doi/full/10.1056/NEJMoa2509426