Apixaban to Prevent Venous Thromboembolism in Patients with Cancer.

Carrier M, Abou-Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A, Kuruvilla P, Hill D, Spadafora S, Marquis K, Trinkaus M, Tomiak A, Lee AYY, Gross PL, Lazo-Langner A, El-Maraghi R, Goss G, Le Gal G, Stewart D, Ramsay T, Rodger M, Witham D, Wells PS; AVERT Investigators.

N Engl J Med. 2018 Dec 4. doi: 10.1056/NEJMoa1814468.

A randomized, placebo-controlled, double-blind trial in cancer patients with an intermediate-to-high risk for venous thromboembolism and starting chemotherapy evaluated the use of apixaban (2.5 mg twice daily) for thromboprophylaxis. Thirteen centres in Canada, randomised 574 patients. Twelve  of 288 patients (4.2%) in the apixaban group and 28 of 275 patients (10.2%) in the placebo group developed venous thrombosis, P<0.001. Major bleeding was significantly higher in the apixaban group (10 patients, 3.5%) than in the placebo group (5 patients, 1.8%); P = 0.046, using the modified intention-to-treat analysis but this was not significant between apixaban and placebo in the analysis of outcomes during the treatment period. Reports of adverse events were 131 patients in the apixaban group and 127 patients in the placebo group. This study did not show significant difference in both groups in overall survival.

Composed by Elaine Boland