Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
Department of Medicine and Thromboembolism Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Gynecol Oncol. 2023 May;172:9-14. doi: 10.1016/j.ygyno.2023.02.012. Epub 2023 Mar 9.
Venous thromboembolic events represent the second most frequent cause of mortality in cancer patients. Recent literature shows that direct oral anticoagulants (DOAC) are at least as effective and safe as low molecular weight heparin for postoperative thromboprophylaxis. However, this practice has not been broadly adopted in gynecologic oncology. The aim of this study was to evaluate clinical effectiveness and safety of apixaban for extended thromboprophylaxis in comparison to enoxaparin after laparotomies for gynecologic oncology patients.
The Gynecologic Oncology Division at a large tertiary center transitioned from enoxaparin 40 mg daily to apixaban 2.5 mg BID for 28 days after laparotomies for gynecologic malignancies in November 2020. This real-world study compared patients post-transition (November 2020 to July 2021 (n = 112)) to a historical cohort (January to November 2020 (n = 144)), using the institutional National Surgical Quality Improvement Program (NSQIP) database. All Canadian gynecologic oncology centers were surveyed to assess postoperative DOAC utilization.
Patient characteristics were similar between groups. No difference was found between total venous thromboembolism rates (4% vs. 3%, p = 0.49). No difference was found in postoperative readmission (5% vs. 6%, p = 0.50). Of the 7 readmissions in the enoxaparin group, one was due to bleeding requiring transfusion; there were no readmissions for bleeding in the apixaban group. No patient required a reoperation for bleeding. Thirteen percent of the 20 Canadian centers have transitioned to extended apixaban thromboprophylaxis.
Apixaban for 28-day postoperative thromboprophylaxis was found to be an effective and safe alternative to enoxaparin after laparotomies in a real-world cohort of gynecologic oncology patients.
静脉血栓栓塞事件是癌症患者死亡的第二大常见原因。最近的文献表明，直接口服抗凝剂（DOAC）在预防术后血栓形成方面与低分子肝素至少同样有效且安全。然而，这种做法在妇科肿瘤学中并未广泛采用。本研究旨在评估阿哌沙班用于妇科肿瘤患者剖腹手术后延长血栓预防的临床效果和安全性，并与依诺肝素进行比较。
2020 年 11 月，一家大型三级中心的妇科肿瘤科将依诺肝素 40mg 每日一次改为阿哌沙班 2.5mg 每日两次，用于妇科恶性肿瘤剖腹手术后 28 天。这项真实世界的研究比较了 2020 年 11 月至 2021 年 7 月（n=112）过渡期后患者与历史队列（2020 年 1 月至 11 月（n=144）），使用机构国家手术质量改进计划（NSQIP）数据库。对所有加拿大妇科肿瘤中心进行调查，以评估术后 DOAC 的使用情况。
两组患者的特征相似。总静脉血栓栓塞发生率无差异（4%比 3%，p=0.49）。术后再入院率无差异（5%比 6%，p=0.50）。依诺肝素组 7 例再入院中有 1 例因出血需要输血；阿哌沙班组无出血再入院。没有患者因出血需要再次手术。20 家加拿大中心中有 13%已过渡到延长阿哌沙班的血栓预防。
在妇科肿瘤患者的真实世界队列中，阿哌沙班用于 28 天术后血栓预防被发现是依诺肝素的有效且安全的替代方案。
