S01E27 | Apixaban vs Rivaroxaban in Acute VTE: The COBRRA Trial

In this episode of PRISM Rounds, we break down the new NEJM 2026 COBRRA trial comparing apixaban vs rivaroxaban for acute venous thromboembolism (VTE).Bottom line: in this randomized head-to-head trial, apixaban reduced clinically relevant bleeding compared with rivaroxaban (3.3% vs 7.1%; RR 0.46), including lower major bleeding (0.4% vs 2.4%), with similar observed recurrent symptomatic VTE rates (1.1% vs 1.0%) over 3 months. NEJM trial: Castellucci LA, Chen VM, Kovacs MJ, et al. Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism. N Engl J Med. 2026;394:1051-1060. DOI: 10.1056/NEJMoa2510703. PubMed: https://pubmed.ncbi.nlm.nih.gov/?term=10.1056%2FNEJMoa2510703NEJM editorial: Moores LK. The COBRRA Trial — Ending the Venous Thromboembolism Safety Toss-up. N Engl J Med. 2026. DOI: 10.1056/NEJMe2600525. PubMed: https://pubmed.ncbi.nlm.nih.gov/?term=10.1056%2FNEJMe2600525Tags#PRISMRounds #MedicalPodcast #MedPodcast #JournalClub #FOAMed #MedEd #EvidenceBasedMedicine #NEJM #JAMA #JAMAInternalMedicine #VTE #VenousThromboembolism #DVT #DeepVeinThrombosis #PE #PulmonaryEmbolism #Apixaban #Rivaroxaban #DOAC #DOACs #Anticoagulation #Thrombosis #Bleeding #BleedingRisk #Hematology #ThrombosisResearch #InternalMedicine #HospitalMedicine #CriticalCare #ICU #PulmCrit #EmergencyMedicine #EM #CardiovascularMedicine #Pharmacy #ClinicalResearch #RCT #RandomizedTrial #PragmaticTrial #COBRRA #PulmonaryCriticalCare #Trainees #Residents #Fellows #MedTwitter #ClinicianEducation #PracticeChanging #NEJMArticle #AcuteVTE