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Peer-reviewedCC BY-NC-NDCardio-oncology (London, England)

Performance status and outcomes in patients with cancer receiving thromboprophylaxis: a subanalysis of the AVERT trial.

  • Nicola Potere1
  • Yan Xu1
  • Ranjeeta Mallick2
  • Tzu-Fei Wang1
  • Danny Hill3
  • Alejandro Lazo-Langner4
  • Vicky Tagalakis5
  • Sudeep Shivakumar6
  • Marcello Di Nisio7
  • Philip S Wells1
  • Marc Carrier8,9,10
10 affiliations
  1. 1Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
  2. 2Ottawa Methods Center, Ottawa Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  3. 3Sault Area Hospital, Sault Ste. Marie, Canada.
  4. 4London Health Sciences Centre, London, Canada.
  5. 5Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.
  6. 6Department of Medicine, Nova Scotia Health, Dalhousie University, Halifax, NS, Canada.
  7. 7Department of Medicine and Ageing Sciences, Gabriele D'Annunzio University, Chieti, Italy.
  8. 8Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. [email protected].
  9. 9Inflammation and Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. [email protected].
  10. 10Division of Hematology, Department of Medicine, The Ottawa Hospital General Campus, Box 201a, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. [email protected].
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Abstract

Background

The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is central to cancer care planning and prognostication. Whether ECOG-PS also carries prognostic value in the setting of primary thromboprophylaxis for cancer-associated venous thromboembolism (VTE) remains unknown.Objectives

To evaluate the impact of ECOG-PS on clinical outcomes in ambulatory patients with cancer initiating chemotherapy.Methods

This was a post-hoc analysis of the AVERT randomized controlled trial that evaluated apixaban (2.5 mg twice daily) for thromboprophylaxis in patients at intermediate-to-high VTE risk. Multivariable survival models assessed the association between ECOG-PS (0-1 versus 2-3) and the composite primary outcome of VTE or clinically relevant bleeding (CRB), as well as its individual components and all-cause mortality, over 180 days.Results

Of 428 patients included, 368 (86.0%) and 60 (14.0%) had an ECOG-PS of 0-1 and 2-3, respectively. The primary composite outcome occurred in 12.8% (n = 47) in those with ECOG 0-1 and 18.3% (n = 11) with ECOG-PS 2-3 (6-month cumulative incidence: 13.0% [95% CI: 9.8%-16.7%] versus 19.9% [95% CI: 10.5%-31.4%], respectively). Worse performance status was associated with higher risks for the composite outcome (aHR: 1.76; 95% CI: 1.14-2.72; p = 0.011), CRB (aHR: 1.58; 95%CI: 1.53-1.63; p < 0.0001), and all-cause mortality (aHR: 5.77; 95% CI: 4.98-6.67; p < 0.0001). In exploratory treatment-effect analyses, apixaban reduced VTE risk across ECOG-PS strata, including among participants with ECOG-PS 2-3, without clear evidence of excess CRB in this subgroup.Conclusions

ECOG-PS predicts VTE-related outcomes in ambulatory patients with cancer and may inform individualized, value-based shared decision-making regarding anticoagulant thromboprophylaxis.

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Cite

BibTeXRIS
BibTeX
@article{potere2026performance,
  title = {{Performance status and outcomes in patients with cancer receiving thromboprophylaxis: a subanalysis of the AVERT trial.}},
  author = {Nicola Potere and Yan Xu and Ranjeeta Mallick and Tzu-Fei Wang and Danny Hill and Alejandro Lazo-Langner and Vicky Tagalakis and Sudeep Shivakumar and Marcello Di Nisio and Philip S Wells and Marc Carrier},
  journal = {Cardio-oncology (London, England)},
  year = {2026},
  month = jul,
  doi = {10.1186/s40959-026-00542-7},
  url = {https://europepmc.org/article/MED/42897686},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Performance status and outcomes in patients with cancer receiving thromboprophylaxis: a subanalysis of the AVERT trial.
AU  - Nicola Potere
AU  - Yan Xu
AU  - Ranjeeta Mallick
AU  - Tzu-Fei Wang
AU  - Danny Hill
AU  - Alejandro Lazo-Langner
AU  - Vicky Tagalakis
AU  - Sudeep Shivakumar
AU  - Marcello Di Nisio
AU  - Philip S Wells
AU  - Marc Carrier
PY  - 2026
DA  - 2026/07/01
JO  - Cardio-oncology (London, England)
DO  - 10.1186/s40959-026-00542-7
UR  - https://europepmc.org/article/MED/42897686
AB  - Background  The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is central to cancer care planning and prognostication. Whether ECOG-PS also carries prognostic value in the setting of primary thromboprophylaxis for cancer-associated venous thromboembolism (VTE) remains unknown.Objectives  To evaluate the impact of ECOG-PS on clinical outcomes in ambulatory patients with cancer initiating chemotherapy.Methods  This was a post-hoc analysis of the AVERT randomized controlled trial that evaluated apixaban (2.5 mg twice daily) for thromboprophylaxis in patients at intermediate-to-high VTE risk. Multivariable survival models assessed the association between ECOG-PS (0-1 versus 2-3) and the composite primary outcome of VTE or clinically relevant bleeding (CRB), as well as its individual components and all-cause mortality, over 180 days.Results  Of 428 patients included, 368 (86.0%) and 60 (14.0%) had an ECOG-PS of 0-1 and 2-3, respectively. The primary composite outcome occurred in 12.8% (n = 47) in those with ECOG 0-1 and 18.3% (n = 11) with ECOG-PS 2-3 (6-month cumulative incidence: 13.0% [95% CI: 9.8%-16.7%] versus 19.9% [95% CI: 10.5%-31.4%], respectively). Worse performance status was associated with higher risks for the composite outcome (aHR: 1.76; 95% CI: 1.14-2.72; p = 0.011), CRB (aHR: 1.58; 95%CI: 1.53-1.63; p < 0.0001), and all-cause mortality (aHR: 5.77; 95% CI: 4.98-6.67; p < 0.0001). In exploratory treatment-effect analyses, apixaban reduced VTE risk across ECOG-PS strata, including among participants with ECOG-PS 2-3, without clear evidence of excess CRB in this subgroup.Conclusions  ECOG-PS predicts VTE-related outcomes in ambulatory patients with cancer and may inform individualized, value-based shared decision-making regarding anticoagulant thromboprophylaxis.
SN  - 2057-3804
ER  -