Eliquis® was as effective as Fragmin® at preventing new blood clots in people with DVT or PE due to cancer.
Unlike other direct oral anticoagulants, Eliquis® was not associated with increased major bleeding compared to Fragmin®.
Understanding the problem
Cancer is a powerful risk factor for forming DVT or PE (about 15 out of every 100 people with cancer will develop a DVT or PE).
Most people with DVT or PE due to cancer are given anticoagulants by needle to protect them from forming new blood clots. The needles contain a medication called low-molecular-weight heparin (LMWH) that is available under different brand names (e.g. Fragmin®). Recent guidelines have recommended that a newer group of pills called direct oral anticoagulant (DOAC) that are available under different brand names (Lixiana® and Xarelto®) can be used to treat most people with DVT or PE due to cancer. While these pills have been shown to be as effective as LMWH for preventing the formation of new blood clots, they have also been shown to increase the risk of major bleeding.
Researchers wondered whether a different type of DOAC, called Eliquis®, is just as effective as LMWH for preventing new blood clots in people with cancer without increasing the risk of major bleeding.
Who? The study included 1155 people with cancer (average age 67; 49% male) and DVT or PE. People were excluded if their doctor thought it was unsafe for them to take DOACs. For example, people with a high risk for bleeding or those with severe medical illnesses affecting kidney or liver function were not included in the study.
What? The study compared the use of Eliquis® versus Fragmin® for 6 months.
Eliquis® 10 mg twice a day for 7 days followed by 5 mg twice a day for 6 months
Fragmin® 200 IU/kg once a day for 30 days followed by 150 IU/kg once a day for 6 months
Eliquis® vs Fragmin® for DVT or PE in people with cancer
Outcomes at 6 months
Rate of events with Eliquis®
Rate of events with Fragmin®
New DVT or PE
6 out of 100 people
8 out of 100 people
4 out of 100 people
4 out of 100 people
*Although the rates for the 2 groups look different, the differences were not statistically significant—this means that the difference could simply be due to chance rather than due to the different treatments.
This Evidence Summary is based on the following article:
Agnelli G, Becattini C, Meyer G, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N Engl J Med. 2020 Apr 23;382(17):1599-1607. doi: 10.1056/NEJMoa1915103. Epub 2020 Mar 29. PubMed
Adam is a 4th year medical student at Ben-Gurion University of the Negev in Israel. He previously completed a Master’s of Science degree in pharmacology at the University of Toronto. He hopes to match into an internal medicine residency program in North America. He wants to include research, including hematological research, into his future studies.
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: Thursday, November 12, 2020