Which DOAC bleeds less in acute VTE?

In this episode, we explore the COBRRA trial comparing apixaban vs rivaroxaban and what it means for clinical practice.

The COBRRA trial provides the first direct, randomized comparison of apixaban and rivaroxaban for the treatment of acute venous thromboembolism (VTE).

In this episode of CLOT Conversations, Dr. Lana Castellucci discusses findings from this landmark study and how they should influence anticoagulant selection.

Key insights include:

Apixaban reduced clinically relevant bleeding by more than 50% compared to rivaroxaban
Differences in bleeding risk emerged early and persisted over the 3-month treatment period
Recurrent VTE and mortality rates were similar between groups
Dosing strategies and early treatment phase appear to play a key role

We also explore real-world considerations, including medication adherence, patient preference, and how to approach populations not included in the trial, such as cancer-associated thrombosis and higher body weight.

This episode provides practical, evidence-based guidance for clinicians managing acute DVT and pulmonary embolism.

Listen now to learn how the COBRRA trial may change your approach to DOAC selection.

Access the publication here:

Castellucci LA, Chen VM, Kovacs MJ, Lazo-Langner A, Greenstreet P, Kahn S, Côté B, Schulman S, De Wit K, Douketis J, Suryanarayan D. Bleeding risk with apixaban vs. rivaroxaban in acute venous thromboembolism. New England Journal of Medicine. 2026 Mar 12;394(11):1051-60.

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