David Green, MD, PhD reviewing Agnelli G et al. J Thromb Haemost 2015 Dec.

Rates of recurrent VTE and bleeding were lower with apixaban than with enoxaparin and warfarin.

Venous thrombosis in cancer patients is usually managed with daily subcutaneous injections of low-molecular-weight heparin (LMWH). To test the safety and efficacy of the new oral anticoagulant apixaban in this setting, investigators conducted an industry-supported, international, randomized, double-blind trial of patients with acute venous thromboembolism (VTE) treated with 6 months of either apixaban (10 mg twice daily for 1 week followed by 5 mg twice daily) or the LMWH enoxaparin (1 mg/kg twice daily for 5 days followed by dose-adjusted warfarin).

Among 513 patients with active cancer or a cancer history, the rate of recurrent VTE was lower with apixaban than with enoxaparin and warfarin (1.9% vs. 6.3%; relative risk, 0.30; 95% confidence interval, 0.11–0.82), as was the rate of major bleeding (1.1% vs. 3.5%; RR, 0.32; 95% CI, 0.09–0.16). The composite outcome of major bleeding and clinically relevant nonmajor bleeding was also lower with apixaban (8.1% vs. 17.4%; RR, 0.47; 95% CI, 0.29–0.75).

Citation(s):

Agnelli G et al. Oral apixaban for the treatment of venous thromboembolism in cancer patients: Results from the AMPLIFY trial. J Thromb Haemost 2015 Dec; 13:2187.

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