2026 Eastern States Conference

Authors: Matthew Schwarztrauber, PharmD; Kira Babinetz, PharmD; Kristen Franklin, PharmD, BCCCP; Vanessa Markle, PharmD, BCPS; Mary Margaret Bliss, PharmD, BCPS

Learning Objective: Describe the rates of recurrent venous thromboembolism in reduced lead-in and full lead-in dosing of apixaban following extended courses of parenteral anticoagulation for the treatment of venous thromboembolism.

Self-Assessment Question: No statistically significant difference was found in recurrent venous thromboembolism rates between the reduced lead-in and full lead-in apixaban dosing groups. True/False

Background/Objective: Compare the rates of recurrent venous thromboembolism (rVTE) within 3 months for full versus reduced apixaban lead-in dosing in patients who had an extended duration of parenteral anticoagulation for the treatment of venous thromboembolism (VTE).

Methods: Multi-center, single health system, retrospective cohort study conducted using electronic health record data. Adult patients who received 24 hours or more of parenteral anticoagulation before starting apixaban for VTE treatment were included. Patients were excluded if they had a history of heparin‑induced thrombocytopenia, a documented clotting disorder, were receiving anticoagulant therapy, or underwent mechanical thrombectomy or fibrinolytic treatment during the initial diagnosis encounter. The two study groups were the reduced lead‑in group (less than 14 doses of apixaban 10 mg) and the full lead‑in group. The primary outcome was the incidence of rVTE within three months of apixaban initiation. Secondary outcomes included length of stay, 3-month all-cause mortality and 30-day readmission.

Results: A total of 2836 patients were identified. Of the 777 patients evaluated for inclusion, 95 and 356 patients were included in the reduced lead-in and full lead-in groups, respectively. Statistically significant differences existed between groups in the following baseline characteristics: age, weight, renal function, and total hours of parenteral anticoagulation. The reduced lead-in group had zero instances of rVTE while full lead-in group had six (p=0.20). The median length of stay was one day longer in the reduced lead-in group (6.3 v. 5.3 days, p=0.008). No significant difference was found between groups for 3-month mortality or 30-day readmission. Due to incomplete data collection, power was unable to be assessed.

Conclusion: The findings of this study do not show a significant difference in rVTE incidence between reduced and full lead-in dosing of apixaban at three months following extended durations of parenteral anticoagulation for treatment of VTE. The validity of this study is limited by incomplete data collection. Future completion of data collection may increase the study's validity.