API-CAT investigators’ decisions on anticoagulation following extended treatment for cancer-associated thrombosis
Authors' conclusion
Prior to unblinding of the API-CAT trial, treatment decisions appeared poorly driven by clinical characteristics, reflecting a ‘therapeutic grey zone’ where anticoagulation was continued in most patients but with highly variable dosing. This exploratory snapshot provides a baseline to monitor the anticipated shift towards wider adoption of reduced-dose apixaban for extended anticoagulation following publication of the API-CAT results. The substantial proportion of treatment discontinuation highlights the need for further studies to identify patients who may safely stop therapy.
Study context
- Population
- Patients with cancer-associated thrombosis enrolled in the API-CAT trial who received at least one dose of study medication, after discontinuation of blinded study treatment and prior to trial unblinding(82.6%) of 1766 randomized patients included in the analysis
- Participants
- 1,458 patients
- Exposure
- Treatment discontinuation vs continuation at a reduced dose vs continuation at a full dose
- Treatment discontinuationn = 198
- Continuation at a reduced dosen = 465
- Continuation at a full dosen = 790
- Outcome
- Anticoagulation after discontinuation of study treatment
Methodological detailspatients from the prospective, multicentre, randomized, double-blind API-CAT trial
- Patients from the prospective, multicentre, randomized, double-blind API-CAT trial
Main finding
As reported in the abstract
- Anticoagulation stopped
- 198 patients (13.6%)
- Anticoagulation continued
- 1260 (86.4%)
- Among those continuing therapy, full-dose anticoagulation
- 790 patients (62.7%)
- Among those continuing therapy, reduced dose
- 465 (36.9%)
- Among those continuing therapy, unknown
- 5
Observational data: associations, not effects.
Further findings
Anticoagulant type
- Direct oral anticoagulants (DOACs)
- 89.6%
- Low-molecular-weight heparin
- 9.9%
Treatment decisions by characteristics
- Generally consistent across patient and cancer characteristics but varied according to timing of treatment discontinuation, physician specialty, and country
Original publication
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