Weekly Journal Scan: Extending anticoagulation beyond 6 months after venous thromboembolism in patients with active cancer. Is low-dose apixaban the answer?

This comment refers to ‘Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism’, published in The New England Journal of Medicine, DOI: 10.1056/NEJMoa2416112. Venous thromboembolism (VTE) is a common and serious complication in cancer patients, driven by hypercoagulability, prolonged physical inactivity, and the pro-thrombotic effects of cancer therapies. Compared with non-cancer patients, those with cancer-associated VTE face higher risks of both recurrence and bleeding while on anticoagulation.2 Current guidelines recommend treatment with low-molecular-weight heparin or a direct oral anticoagulant (DOAC) for at least 6 months.3 Extended anticoagulation is often advised for as long as cancer remains active or treatment continues, though an individualized approach is recommended, as variable bleeding risk may increase the complexity of long-term management.4 While reduced-dose DOACs are supported for extended treatment in non-cancer patients with pulmonary embolism (PE), evidence in the cancer population is scarce.3 The findings of the Associated Thrombosis (API-CAT) study hold important clinical implications, as advances in oncology have enabled patients to live longer with active cancer while receiving treatment, and because bleeding events in this population are associated with increased mortality and reduced quality of life.2 Identifying antithrombotic strategies that may enhance safety while preserving efficacy is therefore a key therapeutic priority in this high-risk population.