After abdominal or pelvic oncological surgery, a significant source of postoperative morbidity is venous thromboembolic events (VTEs). The use of enoxaparin, a subcutaneously injected low molecular weight heparin, for extended-duration VTE prophylaxis (EP) but has been linked to non-compliance. There is a lack of prospective research on the use of newer direct oral anticoagulants in the post-discharge scenario of urologic oncology. The primary objective of this research was to determine whether or if apixaban is equivalent to enoxaparin for EP, and the secondary goal was to increase EP adherence after abdominopelvic oncologic surgery. 

Between August 10, 2020 and September 21, 2021 to assess EP adherence and safety. For 6 months, researchers diligently tracked baseline stats, and then they switched from enoxaparin to apixaban across the board. Noninferiority sample size estimation was used to predict how long it would take to collect the necessary data (145 per group). Consequences of complying were the main measure of success (real or potential barriers to EP use). 

Complications within 30 days of discharge were a secondary result (symptomatic VTE or major bleed). By the end of the baseline period, 161 patients on enoxaparin and 154 on apixaban had been released from the hospital (intervention period). Patients who used enoxaparin were 3.1% more likely to experience an adverse event than those who took apixaban (0%). Predefined noninferiority criteria was satisfied with an absolute risk difference of 3.1% (95% CI: 0.043%-5.8%; P=0.028 for apixaban superiority). The percentage of patients experiencing compliance events while using enoxaparin was 33.5% (P=0.0001), while the percentage of patients taking apixaban was 14.3% (P=0.0001). 

When comparing enoxaparin and apixaban for EP following urologic oncology surgery, apixaban had fewer compliance events. Apixaban is equivalent to enoxaparin in terms of safety and may have less serious side effects.

Source: auajournals.org/doi/full/10.1097/JU.0000000000002788