June 9, 2023

Apixaban Dosing to Optimize Protection from Thrombosis Trial.

Well i’m here with dr. sam goldhaber at brigham women’s hospital who is the lead investigator of the adopt trial one of the late-breaking clinical trials at the american heart association meeting this year this is studying a very key problem in medically ill patients on prophylaxis of dvt and poor embolism you’ve been studying this for a long time sam communicative

Chris lay the groundwork for sure well we have pretty well set what to do when a patient’s in the hospital with an acute medical illness such as congestive heart failure or respiratory failure or pneumonia however when a patient leaves the hospital sometimes their risk of dvt or pulmonary embolism actually increases because they become less mobile at home without

Nurses to prod them or physical therapists and we know that venous thromboembolism and death from venous thromboembolism actually increased during the one month or so after hospital discharge so it’s really one of the last frontiers for us to conquer in the field of venous thromboembolism how do we prevent patients from suffering death or disability from dvt and

Pulmonary embolism after the hospitalization so in this trial is a large randomized file you had a standard arm of in-hospital loma quite heparin versus one of the new oral anticoagulants in hospital and post discharge yes this was a double-blind double dummy study so when patients signed up to participate in the study they were either receiving real anoxia perrin

For 6 to 14 days or a placebo injection and then the other arm was receiving real apixaban 2.5 milligrams twice a day or placebo pills for it and this continued for 30 days and so what were your findings well we hypothesize that a pic seban during the entire intended treatment period would actually be superior to the short course of an ox of paran by reducing vte and

Vte related death there was a trend in that direction but it was not statistically significant okay how about on the bleeding side of things well the good inside there was more major bleeding in the apixaban group most of that was a fall and hematocrit without any clinically overt bleeding whatsoever and when one looks at the combo of major bleeding and clinically

Relevant non major bleeding there was no difference between the two groups the bleeding rate was actually remarkably low in this trial so i guess from this what would you see is the optimal treatment these days of medically ill patient i suppose a heart failure patient vestas sit around in the hospital for getting dire east for a while well for sure we know that

When you leave the hospital the vte rate increases and this trial did not give us the exact prescription of how to decrease that rate but it gave us a lot of important clues i mean for one thing if you look at the event rate you’ll see after the parenteral treatment period is over there’s a sudden spike upward in the venous thromboembolism rate and those who were

Assigned to an ox apparent whereas the apixaban group actually stays quite flat for the rest of the 30 days and i think the clue for clinical trial lyst is to really focus on enrolling patients at the end of the hospitalization rather than at the beginning and putting all the emphasis and what happens from the day of discharge for the next 30 days all right okay

Well more focus i guess on high-risk patients so congratulations through the trial and for cvn i’m chris cannon you you

Transcribed from video
AHA 2011 | ADOPT Trial By American College of Cardiology Video Archive 2