Many patients with active cancer have an increased risk of developing venous thromboembolism (VTE), a condition in which blood clots form deep within veins that can often result in morbidity, mortality, and higher healthcare costs. The drug apixaban can be used to significantly lower the risk of developing VTE in high-risk cancer patients, a study published in the New England Journal of Medicine has shown.

The placebo-controlled, double-blind clinical trial included 574 patients who were determined to be at intermediate-to-high risk for developing venous thromboembolism based on Korana scoring, and who were just initiating chemotherapy. Patients were randomly assigned to apixaban 2.5 mg twice daily or placebo.

At a follow-up period of 180 days, 4.2% of patients in the apixaban group and 10.2% of patients in the placebo group developed VTE. In the modified intention to treat analysis, 3.5% of patients in the apixaban group and 1.8% of patients in the placebo group experienced major bleeding. During treatment, serious bleeding occurred in 2.1% of patients in the apixaban group and 1.1% of patients in the placebo group.

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“Apixaban therapy resulted in a significantly lower rate of venous thromboembolism than did placebo among intermediate-to-high-risk ambulatory patients with cancer who were starting chemotherapy,” stated the authors. However, they caution that apixaban might also increase the risk of major bleeding episodes.


Carrier M, Abou-Nassar K, Mallick R, et al; the AVERT Investigators. Apixaban to prevent venous thromboembolism in patients with cancer [published online December 4, 2018]. N Engl J Med. doi: 10.1056/NEJMoa1814468