SynthesisFrontiers in oncology2025
Reduced versus standard dose apixaban for secondary prevention of cancer-associated venous thromboembolism: A systematic review and meta-analysis.
Synthesis in Frontiers in oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Patients with cancer-associated venous thromboembolism (VTE) often require prolonged anticoagulation because malignancy and chemotherapy can persist for months to years, sustaining both thrombotic and bleeding risks. While full-dose apixaban (5 mg twice daily) is recommended for secondary prevention, extended use may increase bleeding in this vulnerable population. Reducing the dose to 2.5 mg twice daily after six months of full-dose treatment has been proposed to lower bleeding risk without compromising protection against recurrent VTE. To clarify the safety and efficacy of this strategy, we conducted a meta-analysis of randomized controlled trials comparing reduced- versus standard-dose apixaban for extended therapy in patients with cancer-associated VTE. The study followed PRISMA guidelines and was registered in PROSPERO (CRD420251026337). Hazard ratios and risk ratios with 95% confidence intervals were pooled using a random-effects model, and evidence certainty was assessed with GRADE. Two randomized trials comprising 2,126 patients (EVE, n = 360; API-CAT, n = 1,766) met inclusion criteria. The composite outcome of recurrent VTE with bleeding showed a significantly lower risk with reduced-dose apixaban (risk ratio 0.79, 95% CI 0.65-0.96; I Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier PROSPERO CRD420251026337.
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