For people taking blood thinners after experiencing a blood clot, a new study suggests that reducing the dose after six months may lower the risk of bleeding and reduce hospital visits without increasing the risk of new clots.
The research, led by Michigan Medicine, focused on two commonly prescribed blood thinners: rivaroxaban (Xarelto) and apixaban (Eliquis), which belong to a class of drugs called direct oral anticoagulants (DOACs).
Blood clots, also known as venous thromboembolism (VTE), can be life-threatening if they travel to critical areas such as the lungs or brain.
Blood thinners are widely used to prevent clots from forming again, but these medications carry a risk of side effects, particularly bleeding. Striking the right balance between preventing clots and avoiding bleeding is essential for patient safety.
The study analyzed nearly 1,000 cases of patients who were treated for VTE and continued taking DOACs to prevent recurrence. After six months, some patients transitioned to a lower dose, while others stayed on the full therapeutic dose.
The researchers found that both groups had a similar rate of recurrent clotting, but those on the full dose faced a higher risk of bleeding, emergency room visits, and hospitalizations compared to those on the reduced dose.
Dr. Jordan K. Schaefer, the lead author and a clinical associate professor at the University of Michigan Medical School, emphasized the importance of careful monitoring when prescribing these medications.
“DOACs can be lifesaving, but their increased risk of bleeding means we need to be cautious,” he said. The study’s results suggest that for many patients, lowering the dose after six months could reduce complications without compromising the effectiveness of clot prevention.
This study aligns with the 2021 guidelines from the American College of Chest Physicians, which recommend considering a reduced dose of rivaroxaban or apixaban for extended clot prevention.
At the time, these recommendations were described as “weak” due to limited evidence. The new findings provide additional support for the idea that lower doses could be a safer option for many patients.
However, the researchers caution that more studies are needed to confirm these findings.
Randomized clinical trials, which are considered the gold standard in medical research, will be essential to validate the benefits of dose reduction and determine which patients would benefit most from this approach.
Until then, these results offer valuable insights for doctors making decisions about long-term blood thinner use.
Dr. Geoffrey Barnes, senior author of the study and a professor of cardiology at the University of Michigan, highlighted the potential impact of the findings.
“Without randomized trial data, this research provides the strongest evidence we have so far that lower doses can safely prevent recurrent clots while minimizing bleeding risks,” he said.
For patients who have been prescribed DOACs after a blood clot, these findings may encourage conversations with their healthcare providers about the possibility of reducing the dose after six months.
This approach could lead to fewer complications and less need for emergency care, improving quality of life while maintaining effective clot prevention.
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