Doctor, I had a provoked blood clot — should I keep taking apixaban after three months?

In this study, people who developed a blood clot because of a short-term trigger—such as recent surgery, trauma, or a limited period of immobility—but who also had ongoing health risks, such as obesity or chronic inflammation, had a lower risk of another blood clot if they continued low-dose apixaban (2.5 mg twice daily) after their initial treatment of three months. The decision to continue or stop anticoagulation should be based on your personal risk factors for another blood clot as discussed with your doctor.

Study highlights

Compared to those who took placebo, about 9 fewer people out of 100 taking apixaban had another blood clot.

Major bleeding was rare and did not differ between groups. Mild bleeding, such as nosebleeds or bruising, happened in a few more people taking apixaban, but the difference was small.

What's the issue?

People who develop a blood clot (deep vein thrombosis or pulmonary embolism) after a temporary cause, such as surgery, trauma, or being bedridden for at least 3 days (called provoked blood clots), usually take a blood thinner for about three months. After that, treatment is often stopped because the risk of another blood clot is low. However, some people have ongoing health conditions, such as obesity, chronic inflammation, or lung disease, which may increase their risk of another blood clot.

Researchers wanted to know if patients with provoked blood clots and an ongoing health condition should continue a low-dose blood thinner to prevent another blood clot or stop treatment to avoid bleeding.

The study

This randomized, double-blind, placebo-controlled trial (HI-PRO) included 600 adults (average age 59 years, 57% women) who had a blood clot after a temporary trigger but with at least one lasting risk factor such as obesity, chronic lung disease, inflammation, or heart disease.

Patients were randomly assigned to receive either apixaban 2.5 mg twice daily for 12 months or placebo after at least three months of full dose anticoagulation.

Summary of findings

Apixaban vs placebo for prevention of recurrent VTE after a provoked VTE

Outcome (12 months)	Apixaban 2.5 mg twice daily	Placebo	Result
Symptomatic recurrent DVT or PE	1 in 100 people	10 in 100 people	About 9 fewer per 100 people who continued apixaban had another blood clot compared to those taking placebo
Major bleeding	1 in 100 people	0 people	No difference*
Non-major bleeding	5 in 100 people	2 in 100 people	No difference*

*Although the rates for the 2 groups look different, the differences were not statistically significant - this means that the difference could be simply due to chance rather than due to the different treatments

This Evidence Summary is based on the following article:

Piazza G, Bikdeli B, Pandey AK, et al. Apixaban for Extended Treatment of Provoked Venous Thromboembolism. N Engl J Med. 2025 Sep 25;393(12):1166-1176. doi: 10.1056/NEJMoa2509426. Epub 2025 Aug 30. PubMed

Author Details

Talal Alghamdi, MD

Dr Talal Alghamdi is an Internal Medicine resident and an incoming General Internal Medicine resident at McMaster University. He has a strong interest in thrombosis, evidence-based medicine, and clinical education. Dr Alghamdi is actively involved in research and teaching initiatives focused on venous thromboembolism management and patient-centered communication.

Author Details

Anthony Sandre, MD

Dr. Sandre is an Assistant Professor in the Division of General Internal Medicine at McMaster University with additional training in Vascular Medicine. Within the Division of Hematology and Thromboembolism, Dr. Sandre provides care to patients with arterial and venous thrombosis, arteriopathies, and high-risk primary or secondary prevention of cardiovascular disease.

Published: Monday, November 10, 2025

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.

This Evidence Summary was printed from the CLOT+ website on 2025/12/14.

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