Would apixaban be a good option for extended anticoagulation in venous thromboembolism?

The treatment and the long-term management of deep vein thrombosis and pulmonary embolism are a delicate challenging topic. A thoughtful evaluation is warranted to balance the possible risks and benefits of antithrombotic therapy. While there is evidence that anticoagulation can be discontinued after 3 months in most of the patients who experience thromboembolism provoked by precise risk factors [1], conclusive data are still lacking concerning the best treatment regimen for patients with unprovoked venous thromboembolism (VTE), which has a higher rate of recurrence [2]. Some trials address the issue of the possible use in these patients of new anticoagulants, which might be valid alternatives to warfarin due to similar efficacy and administration in fixed doses, without the need for laboratory monitoring. Apixaban is an oral factor Xa inhibitor, which has already been shown to be useful for the prevention of stroke in patients with atrial fibrillation (at a dose of 5 mg twice daily) [3] and for thromboprophylaxis after major orthopedic surgery (at a lower dose of 2.5 mg twice daily) [4]. Summary