CLOT+

Doctor, can I take Eliquis® to treat my blood clot caused by cancer?

A new study has shown that one of the newer anticoagulant pills, Eliquis®, is safe and effective at preventing new blood clots in people with cancer.

Study highlights

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®

vs

Fragmin® 

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® 

Results

New DVT or PE

6 out of 100 people

8 out of 100 people

No difference*


Major Bleeding

4 out of 100 people

4 out of 100 people

No difference

*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

Published: Thursday, November 12, 2020