Thromboprophylaxis With Apixaban For Cancer Patients

Apixaban has been shown to be effective for preventing venous thromboembolism (VTE) in patients with cancer, but is associated with an increased bleeding risk. In a study, published in Thrombosis Research, researchers assessed the safety and effectiveness of thromboprophylaxis with apixaban in cancer patients from the AVERT trial in subgroups based on varying renal function. Primary investigator, Tzu-Fei Wang, reported that patients from the AVERT cohort with creatine clearance (CrCl) less than 60 mL/min “did not have higher risk of thrombotic or bleeding complications compared to those with CrCl ≥60 mL/min.”

Apixaban Study Background

The researchers were motivated by the fact that patients with cancer exhibit a greater risk of renal dysfunction, which the authors suggested “may be associated with increased risk of thrombotic or bleeding complications.” The analysis was performed on two subgroups from the AVERT cohort, in which thromboprophylaxis with apixaban for ambulatory cancer patients was investigated. The primary efficacy measure of this analysis was the incidence of objectively confirmed VTE events within 180 days of randomization. The safety profile was assessed on the basis of major bleeding events.

Thromboprophylaxis with Apixaban Results

According to the article, of the 574 patients enrolled, 66 (11.5%) had CrCl <60 mL/min and 508 (88.5%) had CrCl ≥60 mL/min. Notably, patients with lesser renal function were more likely to be female, have lower weight or body mass index (BMI), and have poorer Eastern Cooperative Oncology Group (ECOG) performance. In these patients, one VTE and one major bleeding event were reported—”with no differences in outcomes between apixaban and placebo.” Conversely, in patients with CrCl ≥60 mL/min, apixaban was associated with a significantly reduced rate of VTE and overall mortality without increased bleeding event risk compared to the placebo group.


Interestingly, the authors observed that the “risk of VTE was significantly higher in patients with CrCl ≥60 mL/min.” In their conclusion, they only stated that, in the AVERT trial, patients with lesser renal function did not appear to have a higher risk of complications compared to patients with greater renal function while undergoing thromboprophylaxis with apixaban.

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