Taking low-dose Xarelto® for 45 days after discharge from hospital for a medical condition (e.g. heart attack, pneumonia, infection) did not reduce the risk of developing VTE compared with not taking an anticoagulant after discharge. These results do not apply to people who have recently had surgery or people who have active cancer.
Patients who took low-dose Xarelto® after hospital discharge did not have a lower risk of DVT, PE, or death than patients who did not take anticoagulants after hospital discharge.
The risk of bleeding was low in both groups.
Understanding the problem
About 2 out of 100 people admitted to a medical ward will develop VTE. Resting in bed slows blood flow in the veins, which increases the chance of forming a DVT. In addition to lying in bed, hospitalized patients often have other risk factors for developing VTE such as certain illnesses (e.g. heart failure, pneumonia, chronic obstructive lung disease or inflammatory diseases), a previous history of VTE, active cancer, and being older than 60 years of age.
A DVT can form days or even several weeks after discharge from hospital. Symptoms include pain or swelling of the leg or if the DVT travels to the lungs, chest pain, shortness of breath, or palpitations.
Anticoagulants can prevent formation of clots. However, the process of blood clotting is also needed to stop bleeding (e.g. when you are cut or injured, clotting helps to stop bleeding). Just as there are risk factors for developing VTE, there are risk factors for bleeding while taking anticoagulants. For example, people who have a previous history of bleeding or active cancer or kidney disease will have a higher risk for bleeding when taking anticoagulants than people who do not have these risk factors. Therefore, anticoagulants are best used when a hospital patient has more than one risk factor for VTE and few or no risk factors for bleeding.
The question asked by researchers in this study was “do people who are in hospital with a medical condition and additional risk factors for developing VTE, and few or no risk factors for bleeding, benefit from taking low-dose Xarelto® for 45 days after discharge?”
Who? The study included 12,019 patients age 40 years or older (mean age 70 years; 52% men), who were hospitalized for at least 3 days on a medical ward and considered to be at high risk for VTE according to a risk score and a D-dimer blood test. The risk score gives points for age, type of medical condition and past medical history. The blood test looks for elevated D-dimers.
What? The study compared patients who received low-dose Xarelto® with patients who received a placebo, which is a substance made to resemble drugs but does not contain an active drug.
Xarelto® 10 mg once a day, for 45 days after hospital discharge
Xarelto® 7.5 mg once a day, in patients with kidney disease
One pill of a placebo once a day for 45 days after hospital discharge
Low-dose Xarelto® vs no anticoagulants after discharge in people hospitalized on a medical ward
Outcomes at 45 days
Rate of events with Xarelto®
Rate of events without anticoagulants
DVT, PE, or death
8 out of 1000 people
11 out of 1000 people
3 out of 1000 people
2 out of 1000 people
*Although the rates for the 2 groups look slightly different, the differences were not statistically significant—this means that the difference could simply be due to chance rather than due to the different treatments.
This Evidence Summary is based on the following article:
Spyropoulos AC, Ageno W, Albers GW, et al. Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness. N Engl J Med. 2018 Aug 26. doi: 10.1056/NEJMoa1805090. PubMed
Thomas Moumneh, MD
Dr. Thomas Moumneh is a French emergency physician currently pursuing additional training with a clinical fellowship in Thrombosis and Hemostasis at the University of Ottawa. He is funded by CanVECTOR, the University of Ottawa, and the French Society of Emergency Medicine (SFMU). He is PhD student and his research interest include prevention of thrombosis in medically ill patients and the diagnosis of pulmonary embolism/myocardial infarction.
Lori-Ann Linkins, MD, MSc (Clin Epi), FRCPC
Dr. Linkins is an Associate Professor of Medicine (thrombosis) at McMaster University in Hamilton, Canada. She holds a Masters Degree in Health Research Methodology and is a Deputy Editor with the Health Information Research Unit, McMaster. Her research interests include heparin-induced thrombocytopenia and cancer-associated thrombosis. She was editor of the ACCP Guidelines, 9th Edition HIT chapter and is currently a member of the ASH VTE Guidelines HIT Panel.
Published: Wednesday, November 7, 2018
Last Updated: Thursday, July 30, 2020