Eliquis niche
I agree that the Eliquis news today does not change the picture for enoxaparin use significantly.
My take is that the niche worth exploring for Eliquis (and its competitors) is the large market of recently discharged medical and surgical patients.
These patients are typically taken off of dvt prophylaxis upon discharge for medical patients or about 6 weeks post op from joint surgery. But, in reality, many of them are medically complex, frail, sedentary patients for whom the objective risk of VTE is not much lower as a result of leaving the hospital.
However, the risks of trying to study this niche are formidable, for the same, confounding reasons---these patients tend to have multiple medical issues, have relatively high risk of bleeding complications, and have relatively high risk of dying, not necessarily from thromboembolic disease. Good luck trying to study this niche.
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