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The American Society of Hematology 2018 guidelines for the prevention of venous thromboembolism (VTE) in patients with active malignancy recommend low-molecular-weight heparin (LMWH), or aspirin if LMWHs are not feasible (Blood Advances 2018; 2:3198). Whether direct oral anticoagulants (DOACs) would be safe and effective for this indication is unclear.
To address this issue, investigators conducted an industry-funded, randomized, placebo-controlled, double-blind trial of the direct factor Xa inhibitor apixaban (2.5 mg twice daily) in 574 ambulatory cancer patients with intermediate-to-high–risk malignancies. Apixaban or placebo was given within 24 hours of starting chemotherapy and continued for 6 months.
VTE was less frequent in patients ass…