In this issue of Blood, Beyer-Westendorf et al analyzed the safety of long-term treatment with the novel oral anticoagulant (NOAC) factor Xa inhibitor, rivaroxaban, in a large registry of patients from their clinical practice with either venous thromboembolism (VTE) or atrial fibrillation. 1 During treatment, the annual major bleeding rate associated with rivaroxaban treatment was 3% to 4%, and did not differ between patients with VTE or atrial fibrillation. In addition, 60% of the major bleeding events were treated conservatively, by compression therapy or blood transfusion. Finally, the mortality rate due to bleeding after 90 days of treatment was 6.3%. All together, this study provides valuable data on the safety of rivoraxaban. Valuable, because most data on the safety of NOACs come from the phase 3 trials and not from clinical practice.
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