Apixaban recommended for blood clot prevention in gynaecologic cancer surgery

Prophylactic apixaban appears to effectively reduce the risk of venous thromboembolism (VTE) for patients undergoing open surgery for gynaecologic malignancies and should be considered the standard of care for VTE prophylaxis in this population, according to a retrospective study.

Researchers examined the medical records of 452 patients with gynaecologic cancer who underwent open surgery and received 28-day postoperative VTE prophylaxis. None of the patients were on anticoagulants preoperatively.

Multivariable logistic regression analysis was conducted to determine the predictors of 90- and 30-day VTE and 30-day bleeding events.

Of the patients, 348 received apixaban and 104 received enoxaparin for VTE prophylaxis. Patients in the enoxaparin group were more likely to be American Society of Anesthesiologists class III/IV (vs I/II; p=0.033), current or former smokers (p=0.012), and have a higher body mass index (p<0.001), Charlson Comorbidity Index (p=0.005), and age (p=0.046).

The rate of VTE at 30 days was significantly lower in the apixaban group than in the enoxaparin group (0.6 percent vs 6.2 percent; adjusted odds ratio [OR], 0.13, 95 percent confidence interval [CI], 0.03–0.56; p=0.006). The VTE rate at 90 days likewise favoured apixaban (2.7 percent 6.2 percent; adjusted OR, 0.85, 95 percent CI, 0.38–1.92; p=0.704).

There was no significant difference between the apixaban and enoxaparin groups in terms of the frequency of major (2.4 percent vs 2.0 percent) and minor bleeding complications (0.9 percent vs 3.0 percent).