Journal: Cardiology in review
This narrative review examines apixaban for both treatment and prophylaxis of cancer‑associated venous thromboembolism (CA‑VTE).
Key points:
- Context: CA‑VTE is common, serious, and historically managed with low–molecular‑weight heparin (LMWH). Direct oral anticoagulants (DOACs), particularly factor Xa inhibitors, are increasingly used but bleeding risk—especially in GI and GU cancers—remains the central concern.
- Efficacy: Data from randomized trials, including CARAVAGGIO and AMPLIFY, show apixaban is noninferior to LMWH and conventional anticoagulation for preventing recurrent VTE in cancer patients. Recurrent VTE rates are similar or lower with apixaban.
- Safety: In selected cancer populations (notably those without active GI lesions), apixaban does not confer a statistically significant increase in major bleeding compared with LMWH or standard therapy.
- Pharmacology: Advantages include oral administration, predictable pharmacokinetics, minimal need for lab monitoring, limited renal clearance, and relatively stable drug exposure—features that support its use in oncology patients and may improve adherence.
- Limitations and gaps: Evidence remains heterogeneous and incomplete across all tumor types, especially higher‑bleeding‑risk malignancies. The authors emphasize the need for additional comparative and real‑world studies to better define which cancer populations derive the most net clinical benefit.