{"doi":"10.1002/ajh.70090","title":"Reduced‐Dose Versus Full‐Dose Direct Oral Anticoagulants for Extended Secondary Venous Thromboembolism Prophylaxis in Cancer Patients: A Systematic Review and Meta‐Analysis of Randomized Trials","abstract":"ABSTRACT Patients with cancer are at high risk for both recurrent venous thromboembolism (VTE) and anticoagulant‐associated bleeding. Direct oral anticoagulants (DOACs) have become a standard option for long‐term VTE management; however, the safety and efficacy of reduced‐dose regimens in cancer populations remain uncertain. We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs) comparing reduced‐dose versus full‐dose DOACs in adult patients with active cancer and prior VTE who had completed at least 6 months of therapeutic anticoagulation. Embase and MEDLINE were searched from inception through April 1, 2025. Primary outcomes were recurrent VTE and a composite of major bleeding and clinically relevant non‐major bleeding. Pooled risk ratios (RRs) were calculated using a random‐effects model. Three RCTs including 2178 patients were eligible. There was no significant difference in recurrent VTE between reduced‐dose and full‐dose apixaban or rivaroxaban (RR, 0.87; 95% CI, 0.10–7.83; I 2 = 0%). The composite bleeding risk was numerically lower with reduced‐dose DOACs (RR, 0.77; 95% CI, 0.55–1.06; p = 0.07; I 2 = 0%). In a subgroup analysis of cancer‐only trials (API‐CAT and EVE; n = 2126), reduced‐dose apixaban significantly reduced the risk of clinically relevant bleeding (RR, 0.77; 95% CI, 0.60–0.99; p = 0.05) without increasing VTE recurrence. Reduced‐dose apixaban or rivaroxaban offers comparable efficacy to full‐dose regimens for extended secondary VTE prophylaxis in cancer patients, with a potential reduction in clinically relevant bleeding. These findings support consideration of dose de‐escalation in select patients with active cancer.","journal":"American Journal of Hematology","year":2025,"id":534803,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9441,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1403255,"name":"Basant Eltaher","orcid":"0000-0003-1255-0408","position":1,"is_corresponding":false},{"id":877460,"name":"Purva Shah","orcid":"0009-0009-4560-0230","position":2,"is_corresponding":false},{"id":257200,"name":"Ranjini Vengilote","orcid":null,"position":3,"is_corresponding":false},{"id":1311251,"name":"Mariam Mostafa","orcid":"0000-0002-3140-3991","position":4,"is_corresponding":false},{"id":334407,"name":"Amber Afzal","orcid":"0000-0003-2790-1995","position":5,"is_corresponding":false},{"id":334408,"name":"Kristen M. Sanfilippo","orcid":"0000-0002-0433-7845","position":6,"is_corresponding":false},{"id":1311250,"name":"Amir Mahmoud","orcid":"0000-0002-0630-1117","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T02:51:52.019261Z","pmid":"40990099","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}