Understanding the problem

Some people who do not have cancer and take apixaban (Eliquis®) for a blood clot may be given the option of taking a low dose of apixaban (2.5 mg twice a day) after 6 months of treatment or continuing with the full dose (5 mg twice a day). Taking a lower dose of apixaban may reduce the risk of bleeding compared to taking the full dose. Both cancer and anticoagulants can cause bleeding that can range from a minor bleed (e.g. nosebleed that last less than 5 minutes) to a major bleed that is severe enough to be considered life-threatening (e.g. bleed into the brain). Clinically relevant nonmajor bleeds are not as serious as major bleeding but still require assessement by a doctor, a medical intervention (e.g. scope), interruption of the medication, or caused discomfort or impairment of activities of daily living. However, cancer can also be a powerful cause of blood clotting which means the low dose of apixaban may not be strong enough to protect people with cancer from having another blood clot.

The researchers wanted to know if people with blood clots due to cancer would have a lower risk of major or clinically relevant non-major bleeding, if they took a low dose of apixaban after 6 to 12 months of treatment compared with people who continued to take full dose apixaban. They also wanted to know if people who took low dose apixaban would have a higher risk of having another blood clot than people who continued to take full dose apixaban.