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Safety of apixaban for venous thromboembolic primary prophylaxis in patients with newly diagnosed malignant glioma

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Abstract

The cumulative incidence of symptomatic venous thromboembolism (VTE) among patients with malignant gliomas (MG) is estimated to be as high as 36% during the course of therapy. Development of VTE is associated with an increased risk of hospitalization, delays in cancer treatment, and an increased risk of complications including intracranial hemorrhage as well as VTE specific symptoms. Despite the high risk of VTE and associated morbidity, there is no standard recommendations regarding long term outpatient VTE prophylaxis in patients with MG due to the lack of clinical trial evidence in this patient population. In this study, we treated ten patients with newly diagnosed MG with apixaban, 2.5 mg twice daily beginning 2–21 days after craniotomy and continuing for up to 6 months. Unacceptable toxicity was defined by ≥ grade 2 CNS or non-CNS hemorrhage, a thromboembolic event (i.e. stroke) or cardiovascular event requiring anticoagulation or anti-platelet therapy. There were no unacceptable toxicities to report and no treatment-related adverse events. None of the patients on the study were diagnosed with a VTE while receiving apixaban. We conclude that apixaban can be given safely to patients with primary MG shortly after craniotomy and should be considered for VTE prevention in these high-risk patients.

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Funding

This study was funded by a pilot grant from the Lake Champlain Cancer Research Organization (Grant No. CON000703-LCCRO 2016).

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Author notes

  1. Heather Wright

    Present address: Department of Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA

Authors and Affiliations

  1. Department of Neurological Sciences, University of Vermont Larner College of Medicine, 149 Beaumont Ave, Given D401, Burlington, VT, 05405, USA

    Alissa A. Thomas & Kelly Chan

  2. Division of Hematology/Oncology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA

    Alissa A. Thomas, Heather Wright, Hannah Ross, Prachi Prasad & Chris E. Holmes

  3. Department of Pathology, University of Vermont Larner College of Medicine, 149 Beaumont Avenue, Burlington, VT, 05405, USA

    Andrew Goodwin

Authors
  1. Alissa A. Thomas
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  2. Heather Wright
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Corresponding author

Correspondence to Alissa A. Thomas.

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Conflict of interest

The authors A. Thomas, H. Wright, K. Chan, H. Ross, P. Prasad, A. Goodwin, and C. Homes have no conflicts of interest to disclose. Dr. Thomas (AAT) is the local principal investigator for clinical trials sponsored by Novocure and by Spectrum Pharmaceuticals.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article does not contain any studies with animals performed by any of the authors.

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Thomas, A.A., Wright, H., Chan, K. et al. Safety of apixaban for venous thromboembolic primary prophylaxis in patients with newly diagnosed malignant glioma. J Thromb Thrombolysis 53, 479–484 (2022). https://doi.org/10.1007/s11239-021-02537-w

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  • DOI: https://doi.org/10.1007/s11239-021-02537-w

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