Modified vs Full Lead-in Dose Apixaban and Rivaroxaban for Treatment of Acute Venous Thromboembolism.

Authors

Jeanette Lahoud, Josephine Jacobs, Lauren Ratrut, Amanda Kitten, Crystal Franco-Martinez

Published in

The Annals of pharmacotherapy. Pages 10600280261456308. Jun 28, 2026. Epub Jun 28, 2026.

Abstract

Apixaban and rivaroxaban, direct oral anticoagulants (DOACs) used for acute venous thromboembolism (VTE) treatment, require higher dose lead-in periods of 7 days and 21 days, respectively. The optimal lead-in duration for patients receiving more than 48 hours of parenteral anticoagulation (AC) is unclear. In addition, guidelines lack recommendations for high bleed-risk patients who might benefit from a shortened lead-in.
This study aimed to evaluate the effectiveness and safety of a modified lead-in strategy, where parenteral AC counts toward shortening or eliminating the DOAC lead-in period, compared to a full lead-in strategy, where a 7-day apixaban or 21-day rivaroxaban lead-in is prescribed irrespective of parenteral AC received.
A retrospective cohort study analyzed patients diagnosed with an acute VTE during hospitalization. Patients were grouped based on a modified versus full lead-in strategy. Primary outcomes of recurrent VTE (rVTE) and bleeding were evaluated at 90 days.
Of 101 included patients, 47 were in the modified lead-in group and 54 in the full lead-in group. Patients in the modified lead-in group had a higher risk of bleeding at baseline. Recurrent VTE occurred in 4 patients in the modified lead-in group, compared to 2 patients in the full lead-in group (9% vs 4%; P = .4129). Bleeding occurred in 10 patients in the modified lead-in group, compared to 3 patients in the full lead-in group (21% vs 6%; P = .0167).
No significant difference in rVTE was observed between groups. The modified lead-in group had a higher incidence of bleeding, possibly reflecting greater baseline risk and clinical complexity rather than the modification itself. Modified lead-in strategies may be reasonable in select patients, particularly those at high risk for bleeding; however, larger studies are needed to confirm safety and efficacy.

PMID:
42365468
Bibliographic data and abstract were imported from PubMed on 28 Jun 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.