Rivaroxaban or aspirin for extended treatment of venous thromboembolism

Many patients with venous thromboembolism (VTE) require extended treatment beyond the standard 6 months if they are felt to be at high risk of recurrence. It remains uncertain as to whether full or lower intensity anticoagulation is required. This randomised, double-blind, phase III trial (Weitz et al. N Engl J Med 2017;376:1211–22) compared once daily rivaroxaban at 20 mg or 10 mg doses with 100 mg of aspirin. Each patient had already completed 6–12 months of treatment dose anticoagulation therapy. A total of 3365 patients were included. The primary efficacy outcome was symptomatic recurrent VTE, and the principal safety outcome was major bleeding. The rate of symptomatic VTE was 1.5% in the 20 mg rivaroxaban group, 1.2% in the 10 mg rivaroxaban group and 4.4% in those receiving aspirin (p<0.001 for both rivaroxaban doses vs aspirin). Rates of major bleeding were 0.5% in the 20 mg rivaroxaban group and 0.4% in the 10 mg rivaroxban group and 0.3% in the aspirin group. Non-major bleeding rates were …