CLINICAL NEWS
For Patients with Cancer and VTE, Apixaban
Associated with Similar Outcomes, Less
Bleeding Than Enoxaparin
Patients with cancer are predisposed to developing venous
thromboembolism (VTE). While a
standard treatment for VTE is the
vitamin K antagonist warfarin, high
rates of recurrence and bleeding
complications have been observed
in this patient population.
Using data from the randomized, double-blind AMPLIFY
study that compared apixaban and
enoxaparin followed by warfarin
in patients with cancer and VTE,
Giancarlo Agnelli, MD, from the
University of Perugia in Italy, and
colleagues conducted a subgroup
analysis in patients with active cancer or a history of cancer at study
inclusion.
Patients were included in the
AMPLIFY study if they were age 18
years or older and had objectively
confirmed symptomatic proximal
deep-vein thrombosis, pulmonary
embolism, or both. Patients were
excluded from the study if they:
• had active bleeding or a high
risk of bleeding
• were receiving treatment
with dual antiplatelet therapy,
aspirin, or potent inhibitors of
cytochrome P450 3A4
• were treated for longer than
48 hours with low-molecularweight heparin (LMWH),
unfractionated heparin, or
fondaparinux
• received treatment of the index VTE with thrombectomy,
vena cava filter, or thrombolytic therapy
• had creatinine clearance of
TABLE.
<25 mL/min, hemoglobin
level of <9 g/dL, or platelet
count of <100,000 mm3
Patients with symptomatic VTE
were randomized to a six-month
course of either:
• Apixaban 10 mg twice daily
for seven days, followed by 5
mg twice daily
• Enoxaparin 1 mg/kg-1 twice
daily for at least five days,
followed by dose-adjusted
warfarin
The study’s primary outcomes
were objectiv Vǒ6