Apixaban for extended thromboprophylaxis after gynecologic cancer surgery significantly reduced patient-reported pain and bruising (p<0.0001) with no change in adherence (92%).
Observational (n=127)
No
Does apixaban improve patient experience and reduce cost compared to enoxaparin for extended thromboprophylaxis after major gynecologic cancer surgery?
Apixaban is an effective and preferred oral alternative to enoxaparin for extended thromboprophylaxis after gynecologic cancer surgery, improving patient experience and reducing financial toxicity without compromising safety or adherence.
p-value: p=<0.0001
OBJECTIVE: Patients undergoing gynecologic cancer surgery at our centre are recommended up to 28 days of enoxaparin for extended post-operative thromboprophylaxis (EP). Baseline survey revealed 92% patient adherence, but highlighted negative effects on patient experience due to the injectable route of administration. We aimed to improve patient experience by reducing pain and bruising by 50%, increasing adherence by 5%, and reducing out-of-pocket cost after introducing apixaban as an oral alternative for EP. METHODS: In this interrupted time series quality improvement study, gynecologic cancer patients were offered a choice between apixaban (2. 5 mg orally twice daily) or enoxaparin (40 mg subcutaneously once daily) at time of discharge. A multidisciplinary team informed project design, implementation, and evaluation. Process interventions included standardized orders, patient and care team education programs. Telephone survey at 1 and 6 weeks and chart audit informed outcome, process, and balancing measures. RESULTS: From August to October 2022, 127 consecutive patients were included. Apixaban was chosen by 84%. Survey response rate was 74%. Patients who chose apixaban reported significantly reduced pain, bruising, increased confidence with administration, and less negative impact of the medication (p < 0. 0001 for all). Adherence was unchanged (92%). The proportion of patients paying less than 125 (apixaban cost threshold) increased from 45% to 91%. There was no difference in bleeding and no VTE events. CONCLUSIONS: Introduction of apixaban for EP was associated with significant improvement in patient-reported quality measures and reduced financial toxicity with no effect on adherence or balancing measures. Apixaban is the preferred anticoagulant for EP at our centre.
Stewart et al. (Wed,) conducted a observational in Gynecologic cancer surgery (n=127). Apixaban vs. Enoxaparin (40 mg subcutaneously once daily) was evaluated on Patient-reported pain, bruising, confidence with administration, and negative impact of medication (p=<0.0001). Apixaban for extended thromboprophylaxis after gynecologic cancer surgery significantly reduced patient-reported pain and bruising (p<0.0001) with no change in adherence (92%).