ASH
ASH 2024: Are reduced-dose anticoagulants effective for extended VTE treatment?
Study design: The Reduced Dose Versus Full-Dose of Direct Oral Anticoagulant After Unprovoked Venous Thromboembolism (RENOVE) trial compared the efficacy and safety of extended anticoagulation with reduced-dose vs. full-dose direct oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) at high risk of recurrence. Patients initially treated for 6 to 24 months were included, and hierarchical sequential testing was used to analyze the outcomes.
Results: Recurrent VTE was observed in 19 of 1,383 patients in the reduced-dose group and 15 of 1,385 patients in the full-dose group, resulting in a 5-year cumulative incidence of 2.2% vs 1.8% (hazard ratio, 1.32; 95% CI, 0.67 to 2.60; P = 0.23 for noninferiority). The 5-year cumulative incidence of clinically relevant bleeding was 9.9% in the reduced-dose group vs. 15.2% in the full-dose group.
Impact on clinical practice: While reduced-dose DOACs may offer a safer profile with fewer bleeding complications, they don't provide equivalent protection against VTE recurrence compared with full-dose regimens. Clinicians should weigh the benefits of reduced bleeding risk against the slightly higher risk of recurrence when considering extended anticoagulation therapy for high-risk VTE.
Source:
Couturaud, F. et al. (2024, December 10). Extended Treatment of Venous Thromboembolism with Reduced- Vs Full-Dose Direct Oral Anticoagulants in Patients at High Risk of Recurrence. Abstract #LBA-3. Presented at American Society of Hematology Annual Meeting & Exposition. https://ash.confex.com/ash/2024/webprogram/Paper212912.html