Welcome back to What's it Worth! Join your host, Dr. Diana Langworthy, and guest host Tim Haas, PharmD Candidate 2028, as they break down the COBRRA trial — a head-to-head comparison of apixaban vs. rivaroxaban for the treatment of acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE).

For years, clinicians have debated whether one DOAC may carry a lower bleeding risk than another, despite both apixaban and rivaroxaban being widely used first-line therapies for acute VTE. Did the COBRRA trial finally give us a clearer answer? Let's dive in and see what it's worth!

• COBRRA was a randomized trial comparing apixaban vs. rivaroxaban in patients with acute symptomatic DVT and PE, with a primary focus on clinically relevant bleeding risk.
• The trial included a broad real-world VTE population, including patients with both provoked and unprovoked thromboembolism, pulmonary embolism, and deep vein thrombosis.
• We break down the Kaplan-Meier curve for clinically relevant bleeding and discuss what the timing of events may tell us about differences between these DOAC regimens.
• The study used a prospective randomized open-label blinded endpoint (PROBE) design, giving us an opportunity to discuss pragmatic trial methodology and real-world applicability.
• Which patients with acute VTE might benefit most from apixaban over rivaroxaban from a bleeding risk perspective? ------> Tune in to find out!

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