For the extended treatment of venous thromboembolism, the newer anticoagulants dabigatran and apixaban show advantages and disadvantages compared with older therapies, according to three studies in the New England Journal of Medicine. (Physician’s First Watch covered the apixaban study when it was published online last December.)

The dabigatran studies, conducted by the manufacturer, included patients who had completed 3 months of initial therapy and whose risks for recurrence were judged to be either at equipoise or increased.

In one study, patients were randomized to dabigatran or warfarin treatment for up to 36 months. Regarding VTE recurrence, dabigatran (1.8%) was noninferior to warfarin (1.3%), and rates of major bleeding did not differ statistically. However, acute coronary syndromes were more frequent with dabigatran (0.9% vs. 0.2%).

The other study compared dabigatran with placebo for up to 12 months. Dabigatran proved superior to placebo in preventing VTE recurrence (0.4% vs. 5.6%). Dabigatran was associated with an almost threefold increased risk for major bleeds.

An editorialist examines the tradeoffs presented by the newer therapies and urges trials that compare them directly with one another, with warfarin, and with aspirin.

Source: NEJM