Bleeding and Thrombotic Events Common With Apixaban in Cancer and AF

Bleeding and thromboembolic events were common among patients with cancer and atrial fibrillation (AF) receiving apixaban in a small real-world cohort, according to a retrospective observational study published in Frontiers in Cardiovascular Medicine.

Investigators evaluated adults treated at a tertiary care center in Saudi Arabia between August 2016 and October 2020. The analysis included 72 patients; their mean age was 71.0 years, 63.9% were female, 90.3% had active cancer, and 76.9% of malignancies were solid tumors. Patients received apixaban for nonvalvular AF with or without venous thromboembolism. The primary thrombotic and safety endpoints were thromboembolic and bleeding events, respectively, within 6 months of apixaban initiation.

During follow-up, 7 patients (9.7%) experienced thromboembolic events, including ischemic stroke in 3 patients and deep vein thrombosis in 3. Bleeding occurred in 26 patients (36.1%), with major bleeding reported in 7 patients, or 9.7% of the full cohort. The upper airway and gastrointestinal tract were the most frequently reported bleeding sites.

In exploratory univariate analyses, gastrointestinal or genitourinary malignancies were associated with higher odds of bleeding than other cancer types (odds ratio [OR], 3.09; 95% CI, 1.08-8.86; P=.041). Baseline hemoglobin below 10g/dL was also associated with higher bleeding odds (OR, 3.01; 95% CI, 1.04-8.68; P=.048). During follow-up, 21 patients died, and apixaban was clinically discontinued in 19 (26.4%), excluding treatment cessation at death.

The authors characterized the findings as hypothesis-generating. They cited the retrospective, single-center design, small cohort, low event counts, lack of a comparator group, and inability to perform multivariable analyses as limitations. They also noted variable follow-up and limited applicability to other oncology populations or other direct oral anticoagulants. Larger prospective studies are needed, they concluded.

Source: Alabdelmuhsin LS, Alwethairi MF, Alharbi D, Almadani OA, Badreldin HA, Alfehaid L. Real-world safety and clinical outcomes of apixaban in patients with cancer and atrial fibrillation. Front Cardiovasc Med. 2026;13:1893856. doi:10.3389/fcvm.2026.1893856