Apixaban Versus Low-Molecular-Weight Heparin for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis

Background: Venous thromboembolism (VTE), particularly in the context of cancer-associated thrombosis (CAT), is a major cause of morbidity and mortality in patients with malignancy. While apixaban has emerged as a potential alternative to low-molecular-weight heparins (LMWHs), uncertainty remains regarding the consistency of its safety profile across different LMWH agents. Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. A comprehensive literature search was performed across PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials. Results: Six randomized controlled trials were included. Apixaban was associated with a reduced risk of recurrent VTE (RR 0.66, 95% CI 0.45–0.96). However, safety outcomes varied depending on the LMWH comparator. Compared with dalteparin, apixaban was associated with a higher risk of clinically relevant non-major bleeding (CRNMB) (log RR 0.38; 95% CI 0.02 to 0.75), whereas, compared with enoxaparin, it was associated with a lower risk (log RR −0.49; 95% CI −0.96 to −0.02). Conclusions: These findings suggest potential differences in safety profiles across individual LMWH agents. However, given the limited number of included trials and clinical heterogeneity, the results should be interpreted cautiously. Further large-scale studies are required to confirm these observations.