Thromb Haemost 2024; 124(04): 351-362
DOI: 10.1055/a-2188-8773
Coagulation and Fibrinolysis

Risk Factors for Bleeding in Cancer Patients Treated with Conventional Dose Followed by Low-Dose Apixaban for Venous Thromboembolism

Parwana Hussaini
1   The Medical Student Research Program, Faculty of Medicine, University of Oslo, Oslo, Norway
Trine-Lise Larsen
2   Department of Hematology, Akershus University Hospital, Lørenskog, Norway
3   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Waleed Ghanima
3   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
4   Clinic of Internal Medicine, Østfold Hospital, Grålum, Norway
Anders Erik Astrup Dahm
2   Department of Hematology, Akershus University Hospital, Lørenskog, Norway
3   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
› Author Affiliations
Funding The study was funded by grants from the Norwegian South-Eastern Health Authority (Grant number 243861), Akershus University Hospital (Grant number 296910), Pfizer Norway, and the Norwegian Research Council (Grant number 271555/F20).


Background Incidence of and risk factors for bleeding in cancer patients with venous thromboembolism (VTE) treated with apixaban are poorly described.

Methods We analyzed data from the prospective CAP study where 298 cancer patients with any type of VTE received 5 mg apixaban twice daily for 6 months, and then 2.5 mg apixaban twice daily for 30 months. For most analyses, major bleedings and clinically relevant nonmajor bleedings were merged to “clinically relevant bleedings.” Risk factors were estimated by odds ratios (OR) and 95% confidence intervals (CIs).

Results The incidence of clinically relevant bleedings was 38% per person-year during the first 6 months of treatment, 21% per person-year from 7 to 12 months, and between 4 and 8% per person-year from 13 to 36 months. Clinically relevant bleedings were associated with age above 74 years (OR: 2.0, 95% CI: 1.0–4.1), body mass index (BMI) below 21.7 (OR: 2.3, 95% CI: 1.1–4.8), and hemoglobin at baseline below 10.5 for females (OR: 2.8, 95% CI: 1.1–7.3) and 11.1 for males (OR: 3.3, 95% CI: 1.3–8.4) during the first 6 months. Gastrointestinal (GI) or urogenital cancer was not associated with clinically relevant bleedings compared with other cancers. Among patients with luminal GI cancer, nonresected cancer had increased risk of bleeding (OR: 3.4, 95% CI: 1.0–11.6) compared with resected GI cancer.

Conclusion There were very few bleedings while patients were on low-dose apixaban. Factors associated with bleeding in patients treated with full-dose apixaban were high age, low BMI, and low hemoglobin, and probably nonresected luminal GI cancer.

Supplementary Material

Publication History

Received: 11 June 2023

Accepted: 09 October 2023

Accepted Manuscript online:
10 October 2023

Article published online:
15 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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