Reduced-Dose Apixaban and Rivaroxaban Versus Low-Molecular-Weight Heparin in Patients With Hematologic Malignancies

NCT ID: NCT07270263

Last Updated: 2025-12-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-11-22

Study Completion Date

2026-12-31

Brief Summary

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This study investigates the efficacy and safety of direct oral anticoagulants (DOACs) in comparison with standard low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolism in patients with hematological malignancies. Eligible participants will be randomized to receive reduced-dose apixaban, reduced-dose rivaroxaban, or standard-dose LMWH. The primary objective is to evaluate the incidence of venous thromboembolism during a 6-month follow-up period. Secondary objectives include assessment of bleeding complications, overall survival, and treatment adherence. The results of this study may provide evidence for safer and more convenient thromboprophylaxis strategies in patients with blood cancers.

Detailed Description

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Patients with hematologic malignancies are at high risk of developing venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) is currently the standard of care for thromboprophylaxis in this population; however, daily subcutaneous administration is burdensome and may impair adherence. Direct oral anticoagulants (DOACs), such as apixaban and rivaroxaban, have demonstrated efficacy in the prevention and treatment of VTE in patients with solid tumors, but data in hematologic malignancies are limited.

This study is designed as a prospective, randomized, open-label, parallel-group trial to compare the efficacy and safety of reduced-dose apixaban and rivaroxaban with standard-dose LMWH in patients with hematologic malignancies requiring primary thromboprophylaxis.

Approximately 100 patients will be randomized in a 1:1:1 ratio to receive:

Apixaban 2.5 mg orally twice daily, Rivaroxaban 10 mg orally once daily, or LMWH (enoxaparin 40 mg subcutaneously once daily or equivalent). The primary endpoint is the incidence of symptomatic or objectively confirmed VTE within 6 months of randomization. Secondary endpoints include major and clinically relevant non-major bleeding events (as defined by ISTH), treatment adherence, and overall survival at 6 months.

This study aims to address the unmet clinical need for optimized, patient-friendly thromboprophylaxis in hematologic malignancies and to provide high-quality data that may guide future clinical practice.

Conditions

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Lymphoma Leukemia Multiple Myeloma (MM), Lymphoma, Large B-Cell, Diffuse (DLBCL), Lymphoma Venous Thromboembolic Disease VTE (Venous Thromboembolism) PE - Pulmonary Embolism Hematologic Malignacies

Keywords

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Apixaban Rivaroxaban Low-Molecular-Weight Heparin Venous Thromboembolism Cancer-Associated Thrombosis Hematologic Malignancies Direct Oral Anticoagulants

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized in a 1:1:1 ratio to receive reduced-dose apixaban, reduced-dose rivaroxaban, or standard low-molecular-weight heparin.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

This is an open-label study; no masking will be applied.

Study Groups

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APIXABAN (reduced dose)

Participants receive apixaban 2.5 mg orally twice daily for at least 6 months.

Group Type EXPERIMENTAL

Apixaban

Intervention Type DRUG

Oral tablet, 2.5 mg twice daily, for at least 6 months.

RIVAROXABAN (reduced dose)

Participants receive rivaroxaban 10 mg orally once daily for at least 6 months.

Group Type EXPERIMENTAL

Rivaroxaban

Intervention Type DRUG

Oral tablet, 10 mg once daily, for at least 6 months.

Low-Molecular-Weight Heparin (LMWH)

Participants receive low-molecular-weight heparin, 40 mg subcutaneously once daily for at least 6 months.

Group Type ACTIVE_COMPARATOR

low molecular weight heparin (enoxaparin sodium)

Intervention Type DRUG

Subcutaneous injection, 40 mg once daily (or equivalent), for at least 6 months.

Interventions

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Apixaban

Oral tablet, 2.5 mg twice daily, for at least 6 months.

Intervention Type DRUG

Rivaroxaban

Oral tablet, 10 mg once daily, for at least 6 months.

Intervention Type DRUG

low molecular weight heparin (enoxaparin sodium)

Subcutaneous injection, 40 mg once daily (or equivalent), for at least 6 months.

Intervention Type DRUG

Other Intervention Names

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Eliquis Poltixa Xarelto Mibrex Zarixa Clexane Neoparin

Eligibility Criteria

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Inclusion Criteria

* Active hematologic malignancy at the time of initiation of systemic therapy, including multiple myeloma, myeloproliferative neoplasm, lymphoma or other hematologic cancer with a Khorana score ≥ 2 points (intermediate or high risk of venous thromboembolism, VTE)
* Use of anticoagulant agents for primary thromboprophylaxis, including direct oral anticoagulants (DOACs) at reduced doses (apixaban 2.5 mg twice daily or rivaroxaban 10 mg once daily) or low-molecular-weight heparin (LMWH) (enoxaparin 40 mg subcutaneously once daily).

Exclusion Criteria

* Major bleeding within the last month (including gastrointestinal or intracranial bleeding).
* Active major bleeding.
* Hemoglobin concentration \< 8 g/dL.
* Thrombocytopenia with platelet count \<30 × 10⁹/L.
* ECOG performance status of 3 or 4.
* Expected survival \<6 months.
* History of mechanical heart valve or severe mitral stenosis.
* Estimated glomerular filtration rate (eGFR) \< 25 mL/min.
* Hepatic impairment (ALT ≥ 3× upper limit of normal or bilirubin ≥ 2× upper limit of normal).
* Acute coronary syndrome or ischemic stroke within the last 6 months.
* Anticipated significant drug-drug interactions between DOACs and anticancer agents.
* Known antiphospholipid syndrome (APS).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Gdansk

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Department of Haematology & Transplantology

Gdansk, Pomeranian Voivodeship, Poland

Site Status RECRUITING

Countries

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Poland

Central Contacts

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Agata Ogłoza-Puchowska, MD

Role: CONTACT

Phone: +48 58 584 43 40

Email: [email protected]

Ewa Lewicka, Professor

Role: CONTACT

Email: [email protected]

Facility Contacts

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Agata Ogłoza-Puchowska, MD, Principle Investigator

Role: primary

Ewa Lewicka, Professor

Role: backup

Other Identifiers

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GUM-HEM-DOAC-2025-01

Identifier Type: -

Identifier Source: org_study_id