Key result
Apixaban for extended thromboprophylaxis after oncologic resection did not significantly reduce 90-day rates of pulmonary embolism (0.7% vs 2.3%, P=0.306) or DVT (1.4% vs 2.8%, P=0.535).
Why the study?
Patients undergoing oncologic resection face increased risk of VTE with associated morbidity and hospital costs, prompting evaluation of apixaban as extended thromboprophylaxis at discharge.
Does apixaban as extended thromboprophylaxis reduce deep vein thrombosis, pulmonary embolism, or mesenteric/portal venous thromboembolism in patients undergoing oncologic resection?
Cohort (n=600)
No
Does apixaban as extended thromboprophylaxis reduce deep vein thrombosis, pulmonary embolism, or mesenteric/portal venous thromboembolism in patients undergoing oncologic resection?
Apixaban as extended thromboprophylaxis after oncologic resection did not produce a statistically significant reduction in VTE events compared to no prophylaxis.
Apixaban may offer convenient ETP after oncologic resection; leaves open need for RCTs confirming safety and efficacy versus LMWH.
Background Patients undergoing oncologic resection are at risk of developing venous thromboembolism (VTE), and this can lead to increased morbidity and hospital costs. Low-molecular weight heparin (LMWH) is recommended as extended thromboprophylaxis (ETP) in high-risk patients and has been shown to reduce rates of VTE. Methods This is a retrospective review of consecutive patients undergoing resection for oncologic indications at a single institution from May 2016 to May 2019. This study evaluated the use of apixaban as ETP at discharge. The primary outcomes were deep vein thrombosis (DVT), pulmonary embolism (PE), or mesenteric/portal venous thromboembolism at 30, 60, and 90 days postoperatively. Results A total of 600 patients were included; 449 patients received no ETP, and 151 patients received apixaban. PE occurred in 1.1, 1.6, and 2.3% of patients without ETP and 0, 0, and .7% of patients in the apixaban group (at 30, 60, and 90 days; P = .338, P = .201, and P = .306, respectively). DVT occurred in 1.8, 2.1, and 2.8% of patients without ETP and 0, 0, and 1.4% in the apixaban group ( P = .211, P = .121, and P = .535, respectively). The total cost, including ETP and readmission for VTE, per patient was US $5.51 more in the apixaban group. Conclusion Apixaban therapy for ETP did not produce a statistically significant reduction in VTE events in our patients. Future studies should include more patients in a prospective multicenter trial.
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Kelly et al. (2023) conducted a cohort in Oncologic resection (n=600). Apixaban vs. No extended thromboprophylaxis was evaluated on Deep vein thrombosis (DVT), pulmonary embolism (PE), or mesenteric/portal venous thromboembolism at 30, 60, and 90 days postoperatively. Apixaban for extended thromboprophylaxis after oncologic resection did not significantly reduce 90-day rates of pulmonary embolism (0.7% vs 2.3%, P=0.306) or DVT (1.4% vs 2.8%, P=0.535).
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