Pd38-07 90-Day Outcomes Comparing Apixaban to Enoxaparin for Thromboprophylaxis After Robotic-Assisted Radical Cystectomy

You have accessJournal of UrologyBladder Cancer: Invasive IV (PD38)1 May 2024PD38-07 90-DAY OUTCOMES COMPARING APIXABAN TO ENOXAPARIN FOR THROMBOPROPHYLAXIS AFTER ROBOTIC-ASSISTED RADICAL CYSTECTOMY Jordan M. Rich, Yuval Elkun, Jack Geduldig, Reuben Ben-David, Neeraja Tillu, Etienne Lavallee, Kyrollis Attalla, Reza Mehrazin, Peter Wiklund, and John P. Sfakianos Jordan M. RichJordan M. Rich , Yuval ElkunYuval Elkun , Jack GeduldigJack Geduldig , Reuben Ben-DavidReuben Ben-David , Neeraja TilluNeeraja Tillu , Etienne LavalleeEtienne Lavallee , Kyrollis AttallaKyrollis Attalla , Reza MehrazinReza Mehrazin , Peter WiklundPeter Wiklund , and John P. SfakianosJohn P. Sfakianos View All Author Informationhttps://doi.org/10.1097/01.JU.0001009424.64728.0c.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditionally, injectable low molecular weight heparin is used as venous thromboembolism (VTE) prophylaxis after robotic-assisted radical cystectomy (RARC). However, direct oral anticoagulants like Apixaban have been recently trialed. We aimed to compare the safety and efficacy of direct oral anticoagulant Apixaban with injectable Enoxaparin after RARC. METHODS: Retrospective review of prospectively collected data for all RARC patients treated at our tertiary care center between 2018-2022. The two study groups were: patients after a prospectively implemented protocol starting in October 2021 utilizing a 21-day postoperative course of Apixaban 2.5mg twice daily after discharge, or patients prior to October 2021 receiving Enoxaparin 40mg daily. VTE rates (defined as DVT or PE) were analyzed. Primary outcome was incidence of symptomatic VTE confirmed with definitive imaging within 90 days of RARC. Descriptive statistics depicted baseline patient characteristics, operative information, complications, and readmissions within 90 days, and differences were compared between groups. Multivariate logistic regression was used to determine associations between variables and the primary outcome. RESULTS: 124 patients received Apixaban prophylaxis, and 250 patients received Enoxaparin prophylaxis. 10 (2.7%) patients experienced a VTE within 90 days post-operatively (2 (1.6%) Apixaban group vs. 8 (3.2%) Enoxaparin group, p=0.5). The apixaban group received fewer blood transfusions during admission (4.8% vs 12%; p=0.03). There were no statistically significant differences in rates of 90-day infection, bleeding, readmissions, or mortality (Table 1). After stratification into European Association of Urology (EAU) risk groups, no statistically significant difference in VTE rates was seen between groups in the Apixaban (2.7% "high + intermediate" vs. 1.1% "low", p=0.5) and Enoxaparin cohorts (4.3% "high + intermediate" vs. 2.5% "low", p=0.5). On multivariate logistic regression, no variables were associated with the development of the primary outcome. CONCLUSIONS: Prophylaxis with Apixaban and Enoxaparin showed no statistically significant differences in VTE rates among RARC patients at 90-days. Apixaban appears safe and effective for VTE prophylaxis after RARC. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e809 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jordan M. Rich More articles by this author Yuval Elkun More articles by this author Jack Geduldig More articles by this author Reuben Ben-David More articles by this author Neeraja Tillu More articles by this author Etienne Lavallee More articles by this author Kyrollis Attalla More articles by this author Reza Mehrazin More articles by this author Peter Wiklund More articles by this author John P. Sfakianos More articles by this author Expand All Advertisement PDF downloadLoading ...