The results of a randomized controlled trial demonstrate that the novel oral anticoagulant apixaban, administered up to 5 days before the start of chemotherapy, significantly reduces the risk of venous thromboembolism (VTE) in patients with intermediate-risk or high-risk cancers of various types, including lymphomas, gynaecological and pancreatic cancers. Patients were randomized 1:1 to receive either apixaban or placebo, followed by chemotherapy appropriate to their cancer type. A total of 12 patients (4.2%) in the apixaban group had VTEs, compared with 28 patients (10.2%) in the placebo group (HR 0.41; 95% CI 0.26– 0.65; P < 0.001). This reduction in VTE risk comes at the cost of an increased risk of major bleeding episodes: major bleeding occurred in 10 patients (3.5%) in the apixaban group versus 5 patients (1.8%) in the placebo group (HR 2.00; 95% CI 1.01– 3.95; P = 0.046). However, results of the competing-risk analysis favour the use of apixaban in this patient population (HR 0.42; 95% CI 0.27–0.65).