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Patient Evidence Summary
Doctor, I have a blood clot due to cancer and have been treated with 6 months of apixaban. Can I take a lower dose now?
Some people with a blood clot caused by cancer who have received treatment with full dose apixaban (5 mg twice a day) for at least 6 months, can safely switch to a lower dose of apixaban (2.5 mg twice a day). People who switch to low dose apixaban are less likely to have bleeding.
Always discuss with your healthcare provider before making any changes to your medications.
Study highlights
Participants with blood clots caused by cancer who took full dose apixaban for 6 months and then switched to a lower dose of apixaban did not have more recurrent blood clots than people who continued to take full dose apixaban.
While a lower dose of apixaban was shown to be effective in preventing blood clots from cancer in a previous study, the present study included five times more participants, and unlike the previous study, it also showed that lower dose apixaban decreased bleeding compared to full dose apixaban.
Most patients with blood clots caused by cancer need to continue taking a blood thinner long-term to prevent new blood clots.
Apixaban is a common blood thinner pill used to treat blood clots caused by cancer, but is associated with increased bleeding compared to patients not taking blood thinners. After initial blood thinner treatment, switching to a lower dose of apixaban may reduce bleeding, but may not be strong enough to prevent another blood clot for patients with cancer.
The researchers wanted to know if people with blood clots due to cancer would have the same blood clot protection and less bleeding if they switched to a lower dose of apixaban after 6 to 12 months of treatment with full dose apixaban. This study adds to previous smaller studies that also looked at this question, but were not big enough to provide a final answer.
Who? The study included 1766 people who had a blood clot caused by cancer and had been treated with full dose apixaban for 6 to 12 months, with a plan to continue on a blood thinner.
Not all people with blood clots caused by cancer were eligible to be included in the trial. People with the following were not studied:
- Blood clots only in an arm or smaller blood clots in the legs or lungs
- People who had severe liver disease
- People who were taking the blood thinner for other reasons in addition to blood clots (e.g., atrial fibrillation)
What?
The study compared low dose apixaban with full dose apixaban for 12 months.
Low dose apixaban | vs | Full dose apixaban |
|---|---|---|
Apixaban 2.5 mg twice a day | Apixaban 5 mg twice a day |
Low dose apixaban vs full dose apixaban in people who have blood clots due to cancer and have been treated with full dose apixaban for at least 6 months
Outcomes at 12 months | Rate of events with low dose apixaban | Rate of events with full dose apixaban | Results |
|---|---|---|---|
Recurrent venous thromboembolism | 2 out of 100 people | 3 out of 100 people | Low dose apixaban was as effective (noninferior) in preventing blood clots compared to full dose apixaban. |
Clinically relevant bleeding | 12 out of 100 people | 16 out of 100 people | About 4 fewer people who switched to low dose apixaban had bleeding compared to people who continued with full dose. Clinically relevant bleeding includes all bleeding events that significantly impact patients (very minor bleeding such as brief nose bleeds and mild bruising are not included). |
This Evidence Summary is based on the following article:
Mahe I, Carrier M, Mayeur D, et al. Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism. N Engl J Med. 2025 Apr 10;392(14):1363-1373. doi: 10.1056/NEJMoa2416112. Epub 2025 Mar 29. PubMed
Eric Cheng, PA
Eric Cheng is a Canadian Certified Physician Assistant and graduate of McMaster University. He worked as a PA in neurology and internal medicine before joining the Thrombosis & Hemostasis team at Toronto General Hospital in 2024. He has a special interest in instructional design and technology, having developed interactive courseware for McMaster University and an online resource platform for the Clinical Teaching Unit at St. Joseph's Healthcare Hamilton.
Zachary Liederman, MD
Zach recently graduated from the University of Toronto Hematology Residency Program and is currently pursuing additional training as both a CanVECTOR fellow and as the Alexandra Yeo Fellow in Thrombosis and Hemostasis at the University of Toronto. He is in the process of completing a Master’s degree in medical education and looks forward to contributing to existing and new teaching projects centered around thromboembolism.
Published: Tuesday, June 17, 2025
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
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This Evidence Summary was printed from the CLOT+ website on 2025/12/05. To view other Evidence Summaries or to register to receive email notifications about new Evidence Summaries, please visit us at https://plus.mcmaster.ca/ClotPlus/Articles/EvidenceSummaries |
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, McMaster University