Last Week in Medicine Extended Apixaban for Provoked VTE (HI-PRO), Coffee and Atrial Fibrillation (DECAF), Age-Adjusted D-dimer for DVT, Beta Blockers after MI with Normal EF, Fish Oil for Dialysis (PISCES), Conservative Dialysis for AKI (LIBERATE-D)
Feb 25, 2026
They debate extended apixaban for provoked VTE and the tradeoff between recurrence reduction and bleeding. They quiz whether coffee affects atrial fibrillation recurrence after cardioversion. They cover age-adjusted D-dimer use to reduce unnecessary imaging. They reassess routine beta blockers after MI with normal ejection fraction. They weigh fish oil benefits in dialysis patients and conservative dialysis strategies for AKI.
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Persistent Risk Factors Move Provoked VTE Toward Unprovoked Risk
- Provoked VTE exists on a spectrum and some patients with persistent risk factors behave like unprovoked cases with high recurrence risk.
- HI-PRO randomized 600 patients with provoked VTE plus enduring risks to apixaban 2.5 mg BID vs placebo and cut VTE from 10% to 1.3% at 12 months.
HI-PRO May Overestimate Baseline Recurrence Due To Selection
- HI-PRO had higher-than-expected placebo recurrence and possible selection issues that limit generalizability.
- The trial was single-center, 77% enrolled by two physicians, and many enduring-risk definitions (eg, atherosclerotic disease) may be broad.
Use Personalized Risk Tools And Shared Decision Making
- Use individualized risk stratification and shared decision-making rather than a strict provoked/unprovoked dichotomy.
- Consider tools like VTEpredict to estimate personalized recurrence and bleeding risks when deciding extended anticoagulation.