Many people who have had a dangerous blood clot need to take blood thinners for months or even years to stop a new clot from forming.
These medicines save lives because blood clots can block important blood vessels and cut off oxygen to the lungs, brain, or other parts of the body.
But blood thinners also have a serious downside: they can cause bleeding. Doctors constantly try to find the safest dose so patients get protection from clots without facing unnecessary bleeding risks.
A new study led by researchers at Michigan Medicine offers encouraging news. It suggests that after someone has been on a blood thinner for six months, lowering the dose may make treatment safer while still offering strong protection against new clots.
The scientists focused on two common medicines: rivaroxaban, known by the brand name Xarelto, and apixaban, known as Eliquis. These drugs belong to a newer group of medications called direct oral anticoagulants. They are widely used today because they are easier to take and require less monitoring compared to older medicines like warfarin.
Blood clots, medically called venous thromboembolism or VTE, often form in the legs but can travel to the lungs, where they become a life-threatening emergency known as pulmonary embolism.
After a clot is treated, doctors usually keep patients on blood thinners to prevent another one from forming. The first few months of treatment are especially important, but the risk of bleeding also increases the longer someone stays on a full-strength dose.
In this study, researchers reviewed almost 1,000 real-life cases of people who were treated for VTE and then continued taking rivaroxaban or apixaban to stop new clots. After six months, some patients stayed on the full dose, while others switched to a lower, extended‑use dose.
This gave scientists a chance to compare outcomes for both groups. The results were clear: the people who remained on the full dose did not get better protection against new clots, but they did have more bleeding, more emergency room visits, and more hospital stays compared to those who switched to a lower dose.
Dr. Jordan K. Schaefer, the lead author of the study, explained that blood thinners work extremely well, but because they increase the chance of bleeding, doctors need to prescribe them carefully.
The study’s findings suggest that lowering the dose after six months may be a good option for many patients because it keeps them safe from new clots while reducing the chance of bleeding events.
These results also support the 2021 guidelines from the American College of Chest Physicians. Those guidelines suggested that after the initial treatment period, patients may safely switch to a reduced dose of rivaroxaban or apixaban for long-term protection.
At the time, experts called the recommendation “weak” because the evidence was limited. This new research adds stronger support and may help doctors feel more confident using reduced doses in everyday practice.
Even so, the scientists point out that more research is needed. The best way to confirm these results would be through large randomized clinical trials, where patients are assigned to either a full dose or a lower dose, allowing for clearer comparisons. For now, the information from this study gives doctors and patients useful guidance while waiting for future research.
Senior author Dr. Geoffrey Barnes said this study offers the best evidence available so far that a lower dose can safely prevent new clots without adding extra bleeding risks.
For patients who take blood thinners after a clot, these findings may open the door to conversations with their doctors about whether reducing the dose at the six‑month mark is a good option. A smaller dose could mean fewer complications, fewer emergency visits, and a better quality of life, all while keeping strong protection against dangerous clots.
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