Efficacy and Safety of Apixaban Thromboprophylaxis According to Baseline Chemotherapy Class in High-Risk Ambulatory Cancer Patients: A Post Hoc Analysis of the AVERT Trial.
Nadia Linxi Feng, John Doering, Tzu-Fei Wang et al.
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In 30 seconds
This post hoc analysis of the randomized, double-blind AVERT trial examined apixaban thromboprophylaxis by baseline chemotherapy class in 563 ambulatory patients with cancer starting chemotherapy. Compared with placebo, apixaban was associated with lower VTE risk across several classes, including platinum-based regimens (HR 0.30, 95% CI 0.16-0.57), without increased bleeding. In placebo-treated patients, platinum-based chemotherapy was associated with higher VTE risk than non-platinum regimens (HR 2.25, 95% CI 1.48-3.42). Testing did not show significant treatment-effect modification by platinum exposure.
Key findings
- Apixaban was associated with lower VTE risk in patients receiving platinum chemotherapy (HR 0.30, 95% CI 0.16-0.57), without increased bleeding.
- VTE risk was also lower with apixaban for taxane, taxane-platinum, topoisomerase inhibitor, and antimetabolite regimens.
- Among placebo recipients, platinum-based chemotherapy was associated with higher VTE risk than non-platinum regimens (HR 2.25, 95% CI 1.48-3.42).
- Treatment-by-platinum interaction testing did not demonstrate significant effect modification.
Why it matters
Chemotherapy class may help contextualize thrombotic risk when considering thromboprophylaxis in ambulatory patients with cancer. The analysis found higher VTE risk with platinum-based regimens in the placebo group and lower VTE risk with apixaban across several classes, while not establishing that platinum exposure changes apixaban’s relative effect.
What to keep in mind
This was an exploratory, post hoc subgroup analysis of a randomized trial; treatment-by-platinum interaction testing did not show significant effect modification.