Title: Incidence of Bleeding in Patients Receiving Parenteral Anticoagulation and Apixaban Therapy for VTE Treatment
Primary: Ashley Hannah,
[email protected]Secondary: Sara Anne Meyer, Lilia Macias, Evaline Inigo, Sarah Lopez
Background: The purpose of this study is to evaluate the association between apixaban dosing and inpatient bleeding in patients treated for venous thromboembolism following initial parenteral anticoagulation. In the inpatient setting, patients with venous thromboembolism are often initiated on parenteral anticoagulation before being transitioned to an oral anticoagulant such as apixaban. This study also aimed to evaluate whether the duration of parenteral anticoagulation was associated with initiation of reduced-dose apixaban. Understanding the factors associated with treatment decisions and clinical outcomes is critical, particularly as bleeding remains a significant complication of anticoagulant therapy.
Methods: A retrospective, randomized controlled trial was conducted involving 289 subjects at St. Joseph’s/Candler Health System from September 2024 to August 2025. Participants received parenteral anticoagulation with either standard heparin or enoxaparin, along with an oral agent. Participants received either 5 mg or 10 mg of apixaban directly following parenteral anticoagulation. This study included patients admitted for a hospital stay that were diagnosed with a venous thromboembolism within twenty-four hours of admission and received treatment with apixaban following parenteral anticoagulation. Participants with a prior history of venous thromboembolism, previous long-term therapeutic anticoagulation with apixaban for three months or severe renal dysfunction were not included. Participants were also excluded if they required anticoagulation therapy plus dual antiplatelet therapy for other indications, or thrombolytic therapy. However, participants on thrombolytic therapy undergoing catheter directed thrombolysis were not excluded.
The primary endpoint of the study was the number of bleeding events documented. Secondary endpoints included the number of patients presenting with first recurrent venous thromboembolism within six months of starting apixaban therapy, confirmed by physician documentation; assessment of severity of illness and its impact on treatment duration, evaluation of total duration of parenteral anticoagulation and its association with initiation of full versus reduced doses of apixaban therapy and lastly, identifying prescriber characteristics and practice settings associated with each treatment approach.
Conclusion: In summary, in this study no statistically significant differences were observed in bleeding events, hemoglobin decline or recurrence rates within six months of therapy between patients initiated on apixaban 5 mg in comparison to 10 mg. Prescribing patterns favored the initiation dose of 10 mg following parenteral anticoagulation for venous thromboembolism. The full dose of 10 mg appeared to be favored among the nine prescriber groups evaluated. Among patients that experienced a bleeding event, hemoglobin decrease greater than 3g/dL or recurrence within six months, apixaban 10 mg was most commonly prescribed.
