geoffrey modest medical blogs

  A recent article found that adults with a provoked venous thromboembolism (VTE) and enduring risk factors are still at risk for a recurrent VTE event and do benefit from long-term anticoagulation, in the company-funded HI-PRO study  (see  dvt provoked prolonged anticoag NEJM2025  in dropbox, or DOI: 10.1056/NEJMoa2509426)   Details : -- 600 adults who had had an objectively-confirmed symptomatic venous thromboembolism (VTE) after a transient provoking risk factor (eg, autoimmune disorders, chronic lung disease, obesity) and had completed the at least 3-month course of anticoagulation were randomized to apixaban 2.5mg twice a day vs placebo for 12 months, in this single-center, double-blind trial done at the Brigham and Women's Hospital in Boston from November 2020 through November 2023 --mean age 59.5, 57% female, 81% white/12% Black/ 9% Latino -- BMI 31, current smokers 5%  -- coexisting conditions: VTE prior to this trial in 21%; diabetes...

  A recent large study of Medicare recipients with atrial fibrillation found that rivaroxaban was associated with more ischemic strokes as well as more hemorrhagic events than apixaban   (see   afib apix better than rivarox JAMA2021  in dropbox, or   doi:10.1001/jama.2021.21222 )   Details:  -- retrospective cohort using the US Medicare database of those >65 years old, finding 581,451 patients with atrial fibrillation, newly prescribed rivaroxaban or apixaban, and followed for 4 years; study from 2013-2018 -- mean age 77, 50% female -- CHA 2 DS 2 -VASc scores: mean 4.2 rivaroxaban, 4.4 apixaban -- comorbidities: hypertension 90%, diabetes 35%, heart failure 30%, anemia 26%, COPD 22%, cancer 18%, GI or other bleeding 15%, CKD stage 3 in 16% -- meds: ACE/ARB 62%, PPI 31%, loop diuretic 28%, oral steroids 25%, diltiazem or verapamil 21%, NSAIDs 17% (though they may have also been OTC), platelet inhibitors 16% -- those on rivaroxaban had a more favorabl...