Oncology
RCT
● RCT
For cancer patients with a leg blood clot and anemia, does longer treatment work better?
Circulation journal : official journal of the Japanese Circulation Society
Published March 30, 2026
Fujiki Shinya, Yamashita Yugo, Morimoto Takeshi, Muraoka Nao, Umetsu Michihisa, Nishimoto Yuji, Taka…
If you have cancer and develop a blood clot in your leg, you're often also dealing with anemia, which is low red blood cell count. This can make treatment decisions tricky. A new analysis looked at whether a blood thinner called edoxaban works differently for these patients depending on how long they take it.
The study involved 601 patients, most of whom had anemia. It compared taking the medication for 12 months versus just 3 months. The goal was to see which approach better prevented another dangerous clot. In patients with anemia, 1.5% of those on the 12-month treatment had another clot or died from one, compared to 8.4% of those on the 3-month treatment. In patients without anemia, the rates were 0% and 4.9%, respectively. This shows that the longer treatment was better at preventing clots in both groups.
When it came to the risk of serious bleeding, the study found no significant difference between taking the drug for 12 months or 3 months, regardless of whether a patient had anemia. This means that for cancer patients with this specific type of leg clot, a full year of treatment offers stronger protection against another clot without a clear increase in major bleeding risk, even if they have anemia.
View Original Abstract ↓
BACKGROUND: The ONCO DVT study demonstrated potential benefits of extended edoxaban treatment in patients with isolated distal deep vein thrombosis in terms of thrombotic risk. However, the risk-benefit balance in patients with anemia remains unclear.
METHODS AND RESULTS: This prespecified subgroup analysis included 601 patients, divided into anemia (n=402) and no-anemia (n=199) groups. The primary endpoint was symptomatic recurrent venous thromboembolism (VTE) or VTE-related death. Anemia was defined as hemoglobin <12 g/dL for women and <13 g/dL for men. In the anemia subgroup, the primary endpoint occurred in 3 (1.5%) and 17 (8.4%) patients in the 12- and 3-month edoxaban treatment groups, respectively (odds ratio [OR] 0.17; 95% confidence interval [CI] 0.05-0.58), compared with 0 and 5 (4.9%) patients, respectively, in the no-anemia subgroup (P interaction=0.997). Major bleeding occurred in 26 (13.1%) and 17 (8.4%) patients with anemia in the 12- and 3-month edoxaban treatment groups, respectively (OR 1.64; 95% CI 0.86-3.14), compared with 2 (2.1%) and 5 (4.9%) patients without anemia (OR 0.67; 95% CI 0.26-1.73; P interaction=0.13).
CONCLUSIONS: Regardless of the presence of anemia, edoxaban treatment for 12 months was superior to treatment for 3 months in reducing thrombotic events, whereas the risk of major bleeding did not differ significantly between the 2 treatment groups.