{"id":138882,"date":"2025-08-31T12:31:24","date_gmt":"2025-08-31T16:31:24","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138882"},"modified":"2026-01-28T15:10:16","modified_gmt":"2026-01-28T20:10:16","slug":"hi-pro-trial-extended-low-intensity-apixaban-reduces-recurrent-vte-in-patients-with-provoked-vte-and-enduring-risk-factors","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138882","title":{"rendered":"HI-PRO Trial: Extended Low-Intensity Apixaban Reduces Recurrent VTE in Patients with Provoked VTE and Enduring Risk Factors"},"content":{"rendered":"<p><b>Key Points:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Standard anticoagulation for provoked venous thromboembolism (VTE) is often discontinued after 3\u20136 months, but patients with enduring risk factors may remain at elevated risk for recurrence.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The HI-PRO trial showed that extended use of low-intensity apixaban (2.5 mg twice daily) significantly reduced symptomatic VTE recurrence over 12 months compared to placebo.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The intervention was well tolerated, with a low incidence of major bleeding.<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">Patients with provoked VTE (e.g. after surgery, trauma, or acute illness) typically receive short-term anticoagulation. However, many of these patients have persistent risk factors, such as obesity, chronic inflammatory conditions, or lung disease, and their long-term risk of recurrence remains unclear. The optimal strategy for extended anticoagulation in such individuals has not been firmly established.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Presented during a Hot Line session at ESC Congress 2025 and simultaneously published in the <\/span><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2416112\"><i><span style=\"font-weight: 400;\">New England Journal of Medicine<\/span><\/i><\/a><span style=\"font-weight: 400;\">, the HI-PRO trial evaluated the safety and efficacy of extended low-dose apixaban in patients with provoked VTE and at least one enduring risk factor.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This double-blind, randomized trial enrolled 600 patients at Brigham and Women\u2019s Hospital in Boston, USA. All participants had experienced a provoked deep vein thrombosis (DVT) or pulmonary embolism (PE), completed at least 3 months of standard-dose anticoagulation, and had at least one enduring risk factor (e.g., BMI \u226530 kg\/m\u00b2, chronic lung disease, chronic inflammatory disease). Patients were randomized 1:1 to receive apixaban 2.5 mg twice daily or placebo for 12 months.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The mean age was 59.5 years, and 57% of participants were women. The most common provoking factors included surgery (33.5%), immobility (31.3%), and trauma (19.2%). Enduring risk factors included chronic inflammatory conditions (52.2%) and obesity (48.2%).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Symptomatic recurrent VTE occurred in just 1.3% of the apixaban group versus 10.0% in the placebo group, representing an 87% relative risk reduction (HR 0.13; 95% CI 0.04\u20130.36; p&lt;0.001). Major bleeding was rare, occurring in 0.3% of apixaban-treated patients and 0% in the placebo group. Clinically relevant non-major bleeding occurred in 4.8% vs. 1.7% of patients (HR 2.68; p=0.059). Deaths were infrequent and balanced between groups.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dr. Gregory Piazza, the study&#8217;s principal investigator, concluded: \u201cLow-intensity apixaban for 12 months effectively reduced symptomatic VTE recurrence with a low risk of major bleeding in patients with provoked VTE and enduring risk factors. Additional research is needed to identify which subgroups benefit most from extended anticoagulation.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Funded by the Bristol-Myers Squibb\/Pfizer Alliance, the HI-PRO trial provides important evidence supporting extended, low-dose anticoagulation in patients traditionally considered low risk after a provoked VTE but who have persistent comorbidities that elevate recurrence risk.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: Standard anticoagulation for provoked venous thromboembolism (VTE) is often discontinued after 3\u20136 months, but patients with enduring risk factors may remain at elevated risk for recurrence. The HI-PRO trial showed that extended use of low-intensity apixaban (2.5 mg twice daily) significantly reduced symptomatic VTE recurrence over 12 months compared to placebo. The intervention [&hellip;]<\/p>\n","protected":false},"author":40615,"featured_media":138883,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[900,8],"tags":[45,901,47,185],"ppma_author":[1069],"class_list":{"0":"post-138882","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-esc-2025","8":"category-news","9":"tag-conference","10":"tag-esc2025","11":"tag-featured","12":"tag-news","13":"author-hassan-adam-alhassan-md"},"authors":[{"term_id":1069,"user_id":40615,"is_guest":0,"slug":"hassan-adam-alhassan-md","display_name":"Hassan Adam Alhassan MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/8cc8318e58bf0ad1548b042cbb04e2e62466d8fe5780d7b1f138246f2c21b2b5?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138882","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40615"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138882"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138882\/revisions"}],"predecessor-version":[{"id":138884,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138882\/revisions\/138884"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138883"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138882"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138882"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138882"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138882"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}