Comparative analysis of apixaban vs. enoxaparin for thromboprophylaxis after radical cystectomy

Radical cystectomy (RC) is the standard treatment for muscle-invasive and select high-risk non-muscle-invasive bladder cancer. Venous thromboembolism (VTE) is a common and preventable postoperative complication. Extended thromboprophylaxis with low-molecular-weight heparin, such as enoxaparin, is recommended, but direct-acting oral anticoagulants like apixaban are a possible alternative. This study evaluated the safety and efficacy of apixaban compared to enoxaparin for extended postoperative thromboprophylaxis following RC. A single-center, observational, before-after study of RCs performed between October 2021 and August 2024 was conducted. Patients receiving 28 days of post-discharge thromboprophylaxis with either enoxaparin or apixaban were included. The primary outcome was postoperative VTE within 30 days. Secondary outcomes included 90-day postoperative VTE, 30-day post-discharge emergency room (ER) visits, readmissions, complications such as bleeding, and 90-day postoperative mortality. A total of 102 patients who received enoxaparin and 83 patients who received apixaban for VTE thromboprophylaxis were included. No significant differences were found in 30-day postoperative VTE rates (0 [0%] apixaban vs. 2 [2%] enoxaparin, p=0.5), 90-day VTE rates, 90-day overall survival, or 30-day post-discharge ER visits, readmissions, or hemorrhagic complications (p>0.05). Apixaban appears to be a safe and effective alternative to enoxaparin for extended postoperative VTE prophylaxis following RC for bladder cancer.