Extended Low-Dose Apixaban in the Long-Term Management of Cancer-Associated Venous Thromboembolism: A Comprehensive Analysis of Efficacy, Safety, and Clinical Implications

Abstract Cancer-associated venous thromboembolism (VTE) represents a significant clinical challenge due to its high incidence and recurrence risk. Apixaban, a direct oral anticoagulant (DOAC), has emerged as a promising option for both acute and extended treatment phases. This article evaluates the efficacy and safety of extended low-dose apixaban (2.5 mg twice daily) for the long-term management of cancer-associated VTE, drawing on clinical trials, observational studies, and mechanistic insights. We discuss dosing strategies, patient selection criteria, bleeding risks, and the role of imaging in monitoring outcomes. The findings suggest that low- dose apixaban offers a favorable balance of efficacy and safety, reducing recurrent VTE while minimizing major bleeding events in cancer patients. Recommendations for clinical practice and future research are provided. Keywords: Cancer-associated VTE, apixaban, low-dose anticoagulation, extended therapy, bleeding risk, imaging.