The Challenge of VTE in Cancer Patients

Venous thromboembolic disease (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a important threat to individuals battling cancer. In fact,VTE is the second leading cause of mortality in cancer patients,surpassed only by the cancer itself. Several factors contribute to this elevated risk, including the release of pro-coagulant substances by cancer cells, inflammation of blood vessels induced by cancer treatments, and the increased risk associated with surgery and invasive medical devices.

According to recent statistics, VTE affects a considerable portion of cancer patients, highlighting the urgent need for effective prevention and treatment strategies. For example, studies show that the incidence of VTE in cancer patients is considerably higher than in the general population.

Landmark Study Explores Reduced Apixaban Dosage

A extensive,randomized,multi-centre study,spanning from 2018 to 2024,investigated the efficacy and safety of a reduced dose of Apixaban in preventing recurrent VTE in cancer patients. The study, coordinated by URC Lariboisière Saint-Louis and promoted by AP-HP, involved 1,766 patients with active cancer across 136 centers in Europe (including England, Austria, Belgium, Spain, France, Greece, Italy, Netherlands, Poland, and Switzerland) and Canada. The average age of participants was 67, with 57% being women. A significant majority (65.8%) had metastatic cancer, and 81.2% were undergoing anticancer treatment at the time of enrollment.

The findings of this pivotal research were unveiled at the American college of Cardiology congress on Saturday, March 29, 2025, and simultaneously published in the prestigious new England Journal of Medicine.

Key Findings: Efficacy and Safety

The primary endpoint of the study focused on the recurrence of VTE or death attributed to VTE during the treatment period. A secondary endpoint assessed the combined risk of major bleeding and bleeding events requiring medical intervention.

The results indicate that prolonged treatment with a reduced dose of Apixaban does not increase the risk of recurrent VTE events in active cancer patients who have already undergone at least six months of anticoagulant therapy for a VTE event. Furthermore, the reduced dose demonstrated a significant 25% reduction in the risk of clinically relevant bleeding compared to the standard dose.

Our results show that, in patients with active cancer having received at least six months of anticoagulant treatment for a TEV event, prolonged treatment with a reduced dose of anticoagulant by Apixaban is not accompanied by the risk of recidivism of TEV event, and makes it possible to reduce the risk of clinically relevant bleeding by 25 % compared to a full dose. We can therefore say that the reduced dose of Apixaban is both as effective and safer as the full dose.
Pr Isabelle mahé, Paris Cité University, head of the internal medicine department of the Louis-Mourier AP-HP hospital.

Implications for Clinical Practice

These compelling findings are poised to influence international guidelines, potentially leading to a shift towards recommending a reduced dose of Apixaban for extended anticoagulant treatment in active cancer patients who have already received at least six months of therapy for a VTE event. This adjustment promises to optimize patient outcomes by minimizing bleeding risks without compromising the effectiveness of VTE prevention.