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Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • Venous thromboembolism (VTE) is a common complication in active cancer patients.
  • Optimal anticoagulation strategies for extended VTE treatment in cancer are not well-defined.
  • The balance between preventing recurrent VTE and minimizing bleeding risk is crucial.

Purpose of the Study:

  • To evaluate the noninferiority of reduced-dose apixaban compared to full-dose apixaban in preventing recurrent VTE.
  • To assess the effect of reduced-dose apixaban on clinically relevant bleeding events.
  • To determine the safety and efficacy of extended anticoagulation in cancer patients with VTE.

Main Methods:

  • A randomized, double-blind, noninferiority trial was conducted.
  • 1766 patients with active cancer and VTE were randomized to receive reduced-dose (2.5 mg) or full-dose (5.0 mg) apixaban twice daily for 12 months.
  • Primary outcome: recurrent VTE; Key secondary outcome: clinically relevant bleeding.

Main Results:

  • Reduced-dose apixaban was noninferior to full-dose apixaban in preventing recurrent VTE (2.1% vs. 2.8%).
  • Reduced-dose apixaban resulted in a significantly lower incidence of clinically relevant bleeding (12.1% vs. 15.6%).
  • Mortality rates were similar between the groups (17.7% vs. 19.6%).

Conclusions:

  • Extended anticoagulation with reduced-dose apixaban is a safe and effective strategy for preventing recurrent VTE in patients with active cancer.
  • Reduced-dose apixaban offers a favorable bleeding profile compared to the full dose.
  • This study supports the use of reduced-dose apixaban for long-term VTE management in this patient population.