LAUSR

We read with great interest the paper by Larsen et al. 1 about low-dose apixaban in extended treatment of cancer- associated thrombosis (CAT) after 6 months of full- dose treatment. The optimal duration of anticoagulant treatment in CAT is a chal-lenge in the current clinical practice. The International Initiative on Thrombosis and Cancer recommends anticoagulant treatment for at least 6 months, and to consider maintaining anticoagulant treatment in case of active cancer. 2 Nevertheless, long- term anticoagulant treatment in patients with CAT is complex because of complications (recurrent venous thromboembolism [VTE] and bleeding) and po-tential drug– drug interactions. The recent evidence available on di-rect oral anticoagulants (DOACs) in patients with CAT has produced changes in clinical practice guidelines. 3,4 In general, DOACs (apix-aban, edoxaban, or rivaroxaban) are recommended in patients with VTE, except in some clinical situations: triple- positive antiphospho-lipid syndrome, pregnancy, severe renal failure, drug– drug interac-tion (glycoprotein