Clinical Outcomes of Rivaroxaban versus LMWH Thromboprophylaxis Following Gynecologic Cancer Surgery: A Retrospective Comparison Study

Purpose: We aimed to evaluate the clinical outcomes of rivaroxaban vs low-molecular-weight heparin (LMWH) for thromboprophylaxis following gynecologic cancer surgery. Patients and Methods: We conducted a retrospective comparative study of rivaroxaban vs standard LMWH in patients undergoing gynecologic malignancy surgery. Clinical outcomes included venous thromboembolism (VTE), major bleeding, non-major bleeding, and 1-year all-cause mortality. A multivariable logistic regression model was used to adjust for potential confounding factors. Results: A total of 250 women were included, 134 received rivaroxaban and 116 received LMWH for postoperative thromboprophylaxis following gynecologic malignancy-related surgery. After adjusting for potential confounding factors using multivariable logistic regression, the 30-day VTE and bleeding events showed no significant differences between the rivaroxaban group and the LMWH groups. There were no cases of 30-day readmission related to surgery, no 30-day mortality, and no all-cause mortality during the 1-year follow-up. Notably, all distal DVT events in both groups were calf muscular vein thromboses. During the 1-year follow-up, no patients were rehospitalized or died due to VTE. Conclusion: We observed no significant differences in short- and long-term outcomes between rivaroxaban and LMWH after gynecologic malignancy surgery. Given the retrospective design and limited number of events, these results should be interpreted with caution, and prospective randomized studies are warranted.