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January 27, 2025Frontiers in OncologyOpen Access

Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism

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Key result

Interacting drugs with apixaban are not linked to recurrent VTE or bleeding in cancer patients.

  • OR 0.95
  • 95% CI 0.38-2.4
  • n=298

Why the study?

It is unclear how drug interactions with apixaban influence recurrent VTE and bleeding outcomes in cancer patients.

Does the concurrent use of interacting drugs influence the risk of recurrent VTE or bleeding in cancer patients treated with apixaban?

Population

298 cancer patients with VTE treated with apixaban

Comparison

Concurrent interacting drugs vs no interacting drugs

Design

Post hoc analysis of a single-arm interventional clinical trial

Follow-up

36-month follow-up period

Authors

MSMarte SvalastogaTLTrine‐Lise LarsenUniversity of OsloJBJorunn BrekkeHaukeland University Hospital

Discussion

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Overview

Concurrent interacting drugs appear compatible with apixaban in cancer VTE; leaves open confirmation in randomized trials.

Study Design

Type

Observational (n=298)

Multicenter

Yes

Structured PICO

Does the concurrent use of interacting drugs influence the risk of recurrent VTE or bleeding in cancer patients treated with apixaban?

P
Population
298 adult patients (18 years or older) with cancer (excluding basal cell or squamous cell carcinoma of the skin) and objectively verified venous thromboembolism (VTE), who did not use strong inhibitors or inducers of CYP3A4 or P-gp.
I
Intervention
Concurrent use of potentially interacting drugs (categorized as increasing bleeding risk, increasing thrombosis risk, or both) alongside apixaban therapy (10 mg twice daily for 1 week, then 5 mg twice daily for 6 months, then 2.5 mg twice daily if continued).
C
Comparator
Patients using no interacting drugs (controls, n=74) alongside apixaban therapy.
O
Outcome
Recurrent VTE, clinically relevant non-major bleeding (CRNMB), and major bleeding during the 36-month follow-up period.hard clinical

Main Result

Effect estimate: OR 0.95 (95% CI 0.38-2.4)

Absolute Event Rate: 9% vs 9.5%

In cancer patients treated with apixaban for VTE, concurrent use of most potentially interacting drugs did not significantly influence clinical outcomes, though fluconazole may increase the risk of clinically relevant non-major bleeding.

Limitations

  • Low number of endpoint events resulting in broad confidence intervals
  • Did not have information on intake of food that could possibly interact with apixaban
  • Many interacting drugs were used for short periods of time
  • Difficult to estimate effects in patients using drugs that can both increase and decrease apixaban efficacy

Cite This Study

Svalastoga et al. (2025) conducted an observational in Cancer with venous thromboembolism (n=298). Drugs expected to increase both bleeding and thrombosis risk (concurrent with apixaban) vs. No interacting drugs was evaluated on Recurrent venous thromboembolism (VTE) (OR 0.95, 95% CI 0.38-2.4). Concurrent use of potentially interacting drugs with apixaban did not significantly influence the risk of recurrent venous thromboembolism (OR 0.95) or bleeding in cancer patients.

synapsesocial.com/papers/6a1c43c41567d2fc4d5fd8c2https://doi.org/10.3389/fonc.2025.1520725
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Evaluation of the efficacy and safety of apixaban and rivaroxaban in cancer patients receiving concomitant active anti-neoplastic therapy at an outpatient cancer setting2020 · 1 citations
  2. 2Impact of concurrent antiplatelet/NSAID use on the safety and efficacy of thromboprophylaxis with apixaban in patients with cancer: A post-hoc analysis of the AVERT trial2025 · 1 citations
  3. 3Effectiveness and Safety of Apixaban vs Warfarin in Patients with Venous Thromboembolism with Risk Factors for Bleeding or for Recurrences2023 · 6 citations
  4. 4Risk Factors for Bleeding in Cancer Patients Treated with Conventional Dose Followed by Low-Dose Apixaban for Venous Thromboembolism2023 · 6 citations
  5. 5Apixaban to Prevent Venous Thromboembolism in Patients with Cancer2018 · 858 citations