Efficacy, safety, and feasibility of Apixaban for postoperative venous thromboembolism prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center
To evaluate safety, efficacy, and feasibility of apixaban for postoperative venous thromboembolism (VTE) prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center. This retrospective, cohort study included patients with gynecologic cancer who underwent open surgery betwe...
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| Veröffentlicht in: | Gynecologic oncology 2024-04, Vol.183, p.120-125 |
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| creator | Knisely, Anne Iniesta, Maria D. Batman, Samantha Meyer, Larissa A. Soliman, Pamela T. Cain, Katherine E. Marten, Claire Chisholm, Gary Schmeler, Kathleen M. Taylor, Jolyn S. Fleming, Nicole D. |
| description | To evaluate safety, efficacy, and feasibility of apixaban for postoperative venous thromboembolism (VTE) prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center.
This retrospective, cohort study included patients with gynecologic cancer who underwent open surgery between 3/2021 and 3/2023 and received 28-day postoperative VTE prophylaxis. Patients on therapeutic anticoagulation preoperatively were excluded. Predictors of 90- and 30-day VTE and 30-day bleeding events were determined using multivariable logistic regression, adjusting for known confounders.
452 patients were included in the cohort: 348 received apixaban and 104 received enoxaparin. Those who received enoxaparin were more likely to be American Society of Anesthesiologists class III/IV (compared to I/II) (p = 0.033), current or former smokers (p = 0.012) and have a higher BMI (p |
| doi_str_mv | 10.1016/j.ygyno.2024.01.039 |
| format | Article |
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This retrospective, cohort study included patients with gynecologic cancer who underwent open surgery between 3/2021 and 3/2023 and received 28-day postoperative VTE prophylaxis. Patients on therapeutic anticoagulation preoperatively were excluded. Predictors of 90- and 30-day VTE and 30-day bleeding events were determined using multivariable logistic regression, adjusting for known confounders.
452 patients were included in the cohort: 348 received apixaban and 104 received enoxaparin. Those who received enoxaparin were more likely to be American Society of Anesthesiologists class III/IV (compared to I/II) (p = 0.033), current or former smokers (p = 0.012) and have a higher BMI (p < 0.001), Charlson Comorbidity Index (p = 0.005), and age (p = 0.046). 30-day VTE rate was significantly lower in the apixaban group (0.6%) compared to the enoxaparin group (6.2%) (adjusted OR 0.13, 95% CI 0.03–0.56; p = 0.006). 90-day VTE rate was 2.7% and 6.2% in the apixaban and enoxaparin groups, respectively (adjusted OR 0.85, 95% CI 0.38–1.92; p = 0.704). Major bleeding complications (2.4% vs. 2.0%) and minor bleeding complications (0.9% vs. 3.0%) were similar in the apixaban and enoxaparin groups, respectively, on multivariate analyses. The median patient out of pocket cost was $10 (IQR 0.0–40.0) for apixaban and $20 (IQR 3.7–67.7) for enoxaparin (p = 0.001).
Our findings along with previously published data suggest that apixaban should be considered the standard of care for VTE prophylaxis in patients undergoing open surgery for gynecologic malignancies.
•30-day venous thromboembolism (VTE) rate was lower in the apixaban (0.6%) compared to enoxaparin group (6.2%) (aOR 0.13).•90-day VTE rate was 2.7% and 6.2% in the apixaban and enoxaparin groups, respectively (aOR 0.85).•Major and minor bleeding complications were similar in the apixaban and enoxaparin groups.•Median patient out of pocket cost was $10 (IQR 0.0–40.0) for apixaban and $20 (IQR 3.7–67.7) for enoxaparin (p = 0.001).</description><identifier>ISSN: 0090-8258</identifier><identifier>ISSN: 1095-6859</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2024.01.039</identifier><identifier>PMID: 38368180</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Apixaban ; Enoxaparin ; Gynecologic cancer ; Thromboembolism prophylaxis</subject><ispartof>Gynecologic oncology, 2024-04, Vol.183, p.120-125</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-d5d0f64ff877ddd524f69f7858d57cc2c29be37592b02b117305d4b53f3f4f063</citedby><cites>FETCH-LOGICAL-c359t-d5d0f64ff877ddd524f69f7858d57cc2c29be37592b02b117305d4b53f3f4f063</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ygyno.2024.01.039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38368180$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Knisely, Anne</creatorcontrib><creatorcontrib>Iniesta, Maria D.</creatorcontrib><creatorcontrib>Batman, Samantha</creatorcontrib><creatorcontrib>Meyer, Larissa A.</creatorcontrib><creatorcontrib>Soliman, Pamela T.</creatorcontrib><creatorcontrib>Cain, Katherine E.</creatorcontrib><creatorcontrib>Marten, Claire</creatorcontrib><creatorcontrib>Chisholm, Gary</creatorcontrib><creatorcontrib>Schmeler, Kathleen M.</creatorcontrib><creatorcontrib>Taylor, Jolyn S.</creatorcontrib><creatorcontrib>Fleming, Nicole D.</creatorcontrib><title>Efficacy, safety, and feasibility of Apixaban for postoperative venous thromboembolism prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>To evaluate safety, efficacy, and feasibility of apixaban for postoperative venous thromboembolism (VTE) prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center.
This retrospective, cohort study included patients with gynecologic cancer who underwent open surgery between 3/2021 and 3/2023 and received 28-day postoperative VTE prophylaxis. Patients on therapeutic anticoagulation preoperatively were excluded. Predictors of 90- and 30-day VTE and 30-day bleeding events were determined using multivariable logistic regression, adjusting for known confounders.
452 patients were included in the cohort: 348 received apixaban and 104 received enoxaparin. Those who received enoxaparin were more likely to be American Society of Anesthesiologists class III/IV (compared to I/II) (p = 0.033), current or former smokers (p = 0.012) and have a higher BMI (p < 0.001), Charlson Comorbidity Index (p = 0.005), and age (p = 0.046). 30-day VTE rate was significantly lower in the apixaban group (0.6%) compared to the enoxaparin group (6.2%) (adjusted OR 0.13, 95% CI 0.03–0.56; p = 0.006). 90-day VTE rate was 2.7% and 6.2% in the apixaban and enoxaparin groups, respectively (adjusted OR 0.85, 95% CI 0.38–1.92; p = 0.704). Major bleeding complications (2.4% vs. 2.0%) and minor bleeding complications (0.9% vs. 3.0%) were similar in the apixaban and enoxaparin groups, respectively, on multivariate analyses. The median patient out of pocket cost was $10 (IQR 0.0–40.0) for apixaban and $20 (IQR 3.7–67.7) for enoxaparin (p = 0.001).
Our findings along with previously published data suggest that apixaban should be considered the standard of care for VTE prophylaxis in patients undergoing open surgery for gynecologic malignancies.
•30-day venous thromboembolism (VTE) rate was lower in the apixaban (0.6%) compared to enoxaparin group (6.2%) (aOR 0.13).•90-day VTE rate was 2.7% and 6.2% in the apixaban and enoxaparin groups, respectively (aOR 0.85).•Major and minor bleeding complications were similar in the apixaban and enoxaparin groups.•Median patient out of pocket cost was $10 (IQR 0.0–40.0) for apixaban and $20 (IQR 3.7–67.7) for enoxaparin (p = 0.001).</description><subject>Apixaban</subject><subject>Enoxaparin</subject><subject>Gynecologic cancer</subject><subject>Thromboembolism prophylaxis</subject><issn>0090-8258</issn><issn>1095-6859</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kcuOEzEQRS0EYkLgC5CQlyzoxo92PxYsRqPhIY3EBtaW2y4njrrtxnbC9EfxjzgksGRRqs29VXXrIPSakpoS2r4_1Otu9aFmhDU1oTXhwxO0oWQQVduL4SnaEDKQqmeiv0EvUjoQQjih7Dm64T1ve9qTDfp1b63TSq_vcFIWcunKG2xBJTe6yeUVB4tvF_eoRuWxDREvIeWwQFTZnQCfwIdjwnkfwzwGKDW5NOMlhmW_TurRpWKapvDT-R0uNo_L0aDDFHZOY628hojTMe4grlhlrLAO8xJhDz6d518VGnyG-BI9s2pK8Orat-j7x_tvd5-rh6-fvtzdPlSaiyFXRhhi28bavuuMMYI1th1s14veiE5rptkwAu_EwEbCRko7ToRpRsEtt40lLd-it5e5JcaPI6QsZ5c0TJPyUNJKNrCeNZyXP24Rv0h1DClFsHKJblZxlZTIMyd5kH84yTMnSagsnIrrzXXBcZzB_PP8BVMEHy4CKDFPDqJM2kF5hXERdJYmuP8u-A1Zxqqu</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Knisely, Anne</creator><creator>Iniesta, Maria D.</creator><creator>Batman, Samantha</creator><creator>Meyer, Larissa A.</creator><creator>Soliman, Pamela T.</creator><creator>Cain, Katherine E.</creator><creator>Marten, Claire</creator><creator>Chisholm, Gary</creator><creator>Schmeler, Kathleen M.</creator><creator>Taylor, Jolyn S.</creator><creator>Fleming, Nicole D.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240401</creationdate><title>Efficacy, safety, and feasibility of Apixaban for postoperative venous thromboembolism prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center</title><author>Knisely, Anne ; Iniesta, Maria D. ; Batman, Samantha ; Meyer, Larissa A. ; Soliman, Pamela T. ; Cain, Katherine E. ; Marten, Claire ; Chisholm, Gary ; Schmeler, Kathleen M. ; Taylor, Jolyn S. ; Fleming, Nicole D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-d5d0f64ff877ddd524f69f7858d57cc2c29be37592b02b117305d4b53f3f4f063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Apixaban</topic><topic>Enoxaparin</topic><topic>Gynecologic cancer</topic><topic>Thromboembolism prophylaxis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Knisely, Anne</creatorcontrib><creatorcontrib>Iniesta, Maria D.</creatorcontrib><creatorcontrib>Batman, Samantha</creatorcontrib><creatorcontrib>Meyer, Larissa A.</creatorcontrib><creatorcontrib>Soliman, Pamela T.</creatorcontrib><creatorcontrib>Cain, Katherine E.</creatorcontrib><creatorcontrib>Marten, Claire</creatorcontrib><creatorcontrib>Chisholm, Gary</creatorcontrib><creatorcontrib>Schmeler, Kathleen M.</creatorcontrib><creatorcontrib>Taylor, Jolyn S.</creatorcontrib><creatorcontrib>Fleming, Nicole D.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Knisely, Anne</au><au>Iniesta, Maria D.</au><au>Batman, Samantha</au><au>Meyer, Larissa A.</au><au>Soliman, Pamela T.</au><au>Cain, Katherine E.</au><au>Marten, Claire</au><au>Chisholm, Gary</au><au>Schmeler, Kathleen M.</au><au>Taylor, Jolyn S.</au><au>Fleming, Nicole D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy, safety, and feasibility of Apixaban for postoperative venous thromboembolism prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>183</volume><spage>120</spage><epage>125</epage><pages>120-125</pages><issn>0090-8258</issn><issn>1095-6859</issn><eissn>1095-6859</eissn><abstract>To evaluate safety, efficacy, and feasibility of apixaban for postoperative venous thromboembolism (VTE) prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center.
This retrospective, cohort study included patients with gynecologic cancer who underwent open surgery between 3/2021 and 3/2023 and received 28-day postoperative VTE prophylaxis. Patients on therapeutic anticoagulation preoperatively were excluded. Predictors of 90- and 30-day VTE and 30-day bleeding events were determined using multivariable logistic regression, adjusting for known confounders.
452 patients were included in the cohort: 348 received apixaban and 104 received enoxaparin. Those who received enoxaparin were more likely to be American Society of Anesthesiologists class III/IV (compared to I/II) (p = 0.033), current or former smokers (p = 0.012) and have a higher BMI (p < 0.001), Charlson Comorbidity Index (p = 0.005), and age (p = 0.046). 30-day VTE rate was significantly lower in the apixaban group (0.6%) compared to the enoxaparin group (6.2%) (adjusted OR 0.13, 95% CI 0.03–0.56; p = 0.006). 90-day VTE rate was 2.7% and 6.2% in the apixaban and enoxaparin groups, respectively (adjusted OR 0.85, 95% CI 0.38–1.92; p = 0.704). Major bleeding complications (2.4% vs. 2.0%) and minor bleeding complications (0.9% vs. 3.0%) were similar in the apixaban and enoxaparin groups, respectively, on multivariate analyses. The median patient out of pocket cost was $10 (IQR 0.0–40.0) for apixaban and $20 (IQR 3.7–67.7) for enoxaparin (p = 0.001).
Our findings along with previously published data suggest that apixaban should be considered the standard of care for VTE prophylaxis in patients undergoing open surgery for gynecologic malignancies.
•30-day venous thromboembolism (VTE) rate was lower in the apixaban (0.6%) compared to enoxaparin group (6.2%) (aOR 0.13).•90-day VTE rate was 2.7% and 6.2% in the apixaban and enoxaparin groups, respectively (aOR 0.85).•Major and minor bleeding complications were similar in the apixaban and enoxaparin groups.•Median patient out of pocket cost was $10 (IQR 0.0–40.0) for apixaban and $20 (IQR 3.7–67.7) for enoxaparin (p = 0.001).</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38368180</pmid><doi>10.1016/j.ygyno.2024.01.039</doi><tpages>6</tpages></addata></record> |
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| source | ScienceDirect Journals (5 years ago - present) |
| subjects | Apixaban Enoxaparin Gynecologic cancer Thromboembolism prophylaxis |
| title | Efficacy, safety, and feasibility of Apixaban for postoperative venous thromboembolism prophylaxis following open gynecologic cancer surgery at a comprehensive cancer center |
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