Bottom Line: Extended low-dose apixaban significantly reduces recurrent VTE in patients with provoked VTE + enduring risk factors, with low major bleeding risk. This will likely change practice and guidelines.

www.nejm.org/doi/ful...

8/8

Clinical Implications: The 10% recurrence rate in placebo group suggests "provoked" VTE with enduring risk factors may have similar recurrence risk to "unprovoked" VTE. Simple provoked vs unprovoked categorization may be insufficient for treatment decisions.

7/8

Study Population: Mean age 59.5 years, 57% female. Most common provoking factors: surgery (33.5%), immobility (31.3%), trauma (19.2%). Most common enduring risk factors: chronic inflammatory disease (52.2%), obesity BMI≥30 (48.2%), atherosclerotic CVD (29.3%).

6/8

Safety Events: Major bleeding: 0.3% (apixaban) vs 0% (placebo). Clinically relevant non-major bleeding: 4.8% vs 1.7% (HR 2.68, P=0.06). One major bleed was a 3mm subdural hematoma after horse fall - no hospitalization required.

5/8

Primary Results: Symptomatic recurrent VTE occurred in 1.3% (apixaban) vs 10.0% (placebo)

- an 87% relative risk reduction (HR 0.13, 95% CI 0.04-0.36, p<0.001)

Number needed to treat = 12

4/8

Study Design: HI-PRO was a randomized, double-blind, placebo-controlled trial.

600 patients with provoked VTE + ≥1 enduring risk factor received apixaban 2.5mg BID vs. placebo for 12 months after completing ≥3 months of initial anticoagulation.

3/8

Background: Current guidelines recommend 3-6 months of anticoagulation for provoked VTE (surgery, trauma, immobility).

What about patients with enduring risk factors like obesity, chronic lung disease, or autoimmune disorders?

2/8

6/7
🔍 Learn more about the projections (incl. brilliant viz) directly from the Guardian article:
www.theguardian.com/...

Thoughts?

5/6
⚖️ Migration is one factor shaping Europe’s future. Employment rates, pension reform & healthcare capacity also matter. Some rural areas face depopulation, but newcomer resettlement projects show potential to revitalize communities.

4/6
🏥 European health systems depend heavily on foreign-trained doctors. Norway, Ireland, Switzerland, UK & Sweden have 30-44% foreign-trained doctors.

🇳🇴 relies on Norwegians educated abroad due to limited domestic medical school slots.

3/6
💸 Tax burdens are rising as pension & elderly care costs grow. These demographic trends will put greater fiscal pressure on governments & societies in decades ahead.

2/6
📉 Low birth rates drive native population decline. Without migration, the EU population could fall from 447M today to ~295M by 2100. The share of 65+ could rise from 21% to 36%, increasing care burdens & government spending.