Macklin Cory S, Reznik Gabrielle, Gleave Martin E, Mannas Miles P, Black Peter C, St-Laurent Marie-Pier
Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
Can Urol Assoc J. 2025 Aug;19(8):236-241. doi: 10.5489/cuaj.9312.
Radical cystectomy (RC) is the standard treatment for muscle-invasive and select high-risk non-muscle-invasive bladder cancer. Venous thromboembolism (VTE) is a common and preventable postoperative complication. Extended thromboprophylaxis with low-molecular-weight heparin, such as enoxaparin, is recommended, but direct-acting oral anticoagulants like apixaban are a possible alternative. This study evaluated the safety and efficacy of apixaban compared to enoxaparin for extended postoperative thromboprophylaxis following RC.
A single-center, observational, before-after study of RCs performed between October 2021 and August 2024 was conducted. Patients receiving 28 days of post-discharge thromboprophylaxis with either enoxaparin or apixaban were included. The primary outcome was postoperative VTE within 30 days. Secondary outcomes included 90-day postoperative VTE, 30-day post-discharge emergency room (ER) visits, readmissions, complications such as bleeding, and 90-day postoperative mortality.
A total of 102 patients who received enoxaparin and 83 patients who received apixaban for VTE thromboprophylaxis were included. No significant differences were found in 30-day postoperative VTE rates (0 [0%] apixaban vs. 2 [2%] enoxaparin, p=0.5), 90-day VTE rates, 90-day overall survival, or 30-day post-discharge ER visits, readmissions, or hemorrhagic complications (p>0.05).
Apixaban appears to be a safe and effective alternative to enoxaparin for extended postoperative VTE prophylaxis following RC for bladder cancer.
根治性膀胱切除术（RC）是肌肉浸润性和部分高危非肌肉浸润性膀胱癌的标准治疗方法。静脉血栓栓塞症（VTE）是一种常见且可预防的术后并发症。推荐使用低分子量肝素（如依诺肝素）进行延长的血栓预防，但阿哌沙班等直接口服抗凝剂也是一种可能的选择。本研究评估了与依诺肝素相比，阿哌沙班在RC术后延长血栓预防中的安全性和有效性。
对2021年10月至2024年8月期间进行的RC手术进行了一项单中心、观察性、前后对照研究。纳入接受依诺肝素或阿哌沙班出院后28天血栓预防的患者。主要结局是30天内的术后VTE。次要结局包括术后90天的VTE、出院后30天的急诊室（ER）就诊、再入院、出血等并发症以及术后90天的死亡率。
共有102例接受依诺肝素和83例接受阿哌沙班进行VTE血栓预防的患者纳入研究。术后30天VTE发生率（阿哌沙班为0 [0%]，依诺肝素为2 [2%]，p = 0.5）、90天VTE发生率、90天总生存率、出院后30天ER就诊、再入院或出血并发症方面均未发现显著差异（p>0.05）。
对于膀胱癌RC术后延长的VTE预防，阿哌沙班似乎是依诺肝素的一种安全有效的替代药物。
