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This systematic review and meta-analysis pooled randomized controlled trials comparing reduced-dose versus standard-dose apixaban for extended treatment, following PRISMA and PROSPERO registration, and assessed effects using pooled hazard and risk ratios with GRADE.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/reduced-versus-standard-dose-apixaban-for-secondary-prevention-of-cancer-associated-venous-thromboembolism-a-systematic-review-and-meta-analysis/417658/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/reduced-versus-standard-dose-apixaban-for-secondary-prevention-of-cancer-associated-venous-thromboembolism-a-systematic-review-and-meta-analysis/417658.png","ImageObject",300,407,{"name":42,"@type":43},"Lucas Martin","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is extended anticoagulation important for cancer-associated VTE?","Question",{"text":63,"@type":64},"Malignancy and cancer therapies can persist for months to years, sustaining both thrombotic and bleeding risks. Extended anticoagulation helps prevent recurrence.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How does reduced-dose apixaban compare with standard-dose for extended therapy?",{"text":68,"@type":64},"Pooled trial data showed a significantly lower risk for recurrent VTE with bleeding and for major plus clinically relevant nonmajor bleeding with reduced-dose apixaban.",{"name":70,"@type":61,"acceptedAnswer":71},"Were there differences in major outcomes like recurrent VTE or mortality?",{"text":72,"@type":64},"No significant differences were observed for recurrent VTE, major bleeding, clinically relevant nonmajor bleeding, mortality, deep-vein thrombosis, or pulmonary embolism.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},417658,1790792042,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","TYPE Systematic Review PUBLISHED 19 December 2025 DOI 10.3389/fonc.2025.1690984  \nOPEN ACCESS  \nEDITED BY  \nLin Zhao,  \nCapital Medical University, China  \nREVIEWED BY  \nTirath Patel,  \nAmerican University of Antigua, Antigua and Barbuda  \nMiguel Arce Huamani,  \nUniversidad Norbert Wiener, Peru  \n*CORRESPONDENCE  \nVasu Malhotra  \n[Vasu.Malhotra@myLRH.org](Vasu.Malhotra@myLRH.org)  \nRECEIVED 22 August 2025  \nREVISED 10 November 2025  \nACCEPTED 17 November 2025  \nPUBLISHED 19 December 2025  \nCITATION  \nMalhotra V, Patel SG, Feinaj A, Amin D, Ash H, Boozo MB, Breslow Z, Trube J, Farooq MZ and Sabina M (2025) Reduced versus standard dose apixaban for secondary prevention of cancer-associated venous thromboembolism:  \nA systematic review and meta-analysis. Front. Oncol. 15:1690984 .  \ndoi: 10.3389/fonc.2025.1690984  \nCOPYRIGHT  \n© 2025 Malhotra, Patel, Feinaj, Amin, Ash, Boozo, Breslow, Trube, Farooq and Sabina. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nReduced versus standard dose apixaban for secondary prevention of cancer-associated venous thromboembolism: A systematic review and metaanalysis  \nVasu Malhotra 1*, Shreya G. Patel 1, Ardit Feinaj 1, Devesh Amin 1, Henry Ash1, Mohammad B. Boozo 2, Zachary Breslow 1, Jennifer Trube1, Muhammad Z. Farooq 3 and Michael Sabina 1  \n1 Department of Internal Medicine, Lakeland Regional Health, Lakeland, FL, United States, 2 Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States,  \n3 Department of Hematology & Oncology, Lakeland Regional Health, Lakeland, FL, United States  \nPatients with cancer-associated venous thromboembolism (VTE) often require prolonged anticoagulation because malignancy and chemotherapy can persist for months to years, sustaining both thrombotic and bleeding risks. While fulldose apixaban (5 mg twice daily) is recommended for secondary prevention, extended use may increase bleeding in this vulnerable population. Reducing the dose to 2.5 mg twice daily after six months of full-dose treatment has been proposed to lower bleeding risk without compromising protection against recurrent VTE. To clarify the safety and efficacy of this strategy, we conducted a meta-analysis of randomized controlled trials comparing reduced- versus standard-dose apixaban for extended therapy in patients with cancerassociated VTE. The study followed PRISMA guidelines and was registered in PROSPERO (CRD420251026337) . Hazard ratios and risk ratios with 95% confidence intervals were pooled using a random-effects model, and evidence certainty was assessed with GRADE. Two randomized trials comprising 2,126 patients (EVE, n = 360; API-CAT, n = 1,766) met inclusion criteria. The composite outcome of recurrent VTE with bleeding showed a significantly lower risk with reduced-dose apixaban (risk ratio 0 .79, 95% CI 0 .65–0. 96; I2 = 0%), and the composite of major and clinically relevant nonmajor bleeding was also reduced (HR 0 .75 (95% CI 0 .63–0. 88; I2 = 0%) . No significant differences were observed for recurrent VTE, major bleeding, clinically relevant nonmajor bleeding, mortality, deep-vein thrombosis, or pulmonary embolism. These findings indicate that reduced-dose apixa ban after the initial six months of anticoagulation decreases bleeding without loss of efficacy, supporting dose  \nFrontiers in Oncology 01 [frontiersin.org](frontiersin.org)  \nde-escalation as a safe, evidence-based approach for extended anticoagulation in cancer-associated VTE.  \nSystematic review registration: [https://www.crd.york.ac.uk/prospero/](https://www.crd.york.ac.uk/p","cbCaiovv9VymOHxl","https://ap.wps.com/l/cbCaiovv9VymOHxl","pdf",3244427,11,"English","# Introduction\n# Methods\n## Outcomes and effect measures\n## Evidence appraisal\n# Results\n## Recurrent VTE and bleeding outcomes\n# Discussion","[{\"question\":\"Why is extended anticoagulation important for cancer-associated VTE?\",\"answer\":\"Malignancy and cancer therapies can persist for months to years, sustaining both thrombotic and bleeding risks. Extended anticoagulation helps prevent recurrence.\"},{\"question\":\"How does reduced-dose apixaban compare with standard-dose for extended therapy?\",\"answer\":\"Pooled trial data showed a significantly lower risk for recurrent VTE with bleeding and for major plus clinically relevant nonmajor bleeding with reduced-dose apixaban.\"},{\"question\":\"Were there differences in major outcomes like recurrent VTE or mortality?\",\"answer\":\"No significant differences were observed for recurrent VTE, major bleeding, clinically relevant nonmajor bleeding, mortality, deep-vein thrombosis, or pulmonary embolism.\"}]","Reduced versus standard dose apixaban for secondary prevention of cancer-associated venous thromboembolism - A systematic review and meta-analysis | PDF",1790610015,28]