South Central Section of the AUA 2022

SCS AUA 2022: Comparison of Apixaban Vs Enoxaparin for Extended Venous Thromboembolism

( Patients undergoing radical cystectomy have an increased risk of venous thromboembolism, with associated morbidity. Current guidelines recommend the use of extended thromboprophylaxis, traditionally with injectable enoxaparin. Apixaban has been utilized in the orthopedic literature for a similar purpose and has shown equivalent outcomes to injectable heparins. They aimed to compare injectable extended thromboprophylaxis with enoxaparin to an oral apixaban alternative.

The authors performed a retrospective study from two academic referral centers, including 147 patients (45 enoxaparin, and 102 apixaban). Inclusion criteria included radical cystectomy for malignancy, use of thromboprophylaxis for 28 days postoperatively, and follow up data regarding complications. Apixaban was provided as 2.5mg orally twice daily. The primary outcome was the presence of symptomatic venous thromboembolism. Secondary outcomes included 30-day readmission and complications.

They found that out of a total of 147 patients, 69.4% were given apixaban, and 30.6% given enoxaparin. There were no significant differences in age, gender, Charlson comorbidity scores, or use of neoadjuvant chemotherapy. The hospital length of stay was significantly shorter for apixaban (7.2 vs. 9.5 days, p=0.005). There was no difference in pT staging or pN positive disease between cohorts. The rate of symptomatic DVT was 3.4% overall with no significant difference between apixaban or enoxaparin cohorts (3.9% vs 2.3%, respectively, p=0.62). A multivariable logistic regression for the development of venous thromboembolism was performed including age, gender, Charlson score, neoadjuvant chemotherapy, pathologic staging, and use of apixaban. No factor was significantly associated with venous thromboembolism. The rate of postoperative complication was similar between cohorts (59.1% vs 53.9%, p=0.59), and the rate of 30-day readmission was also similar (26.2% vs 36.1%, p=0.33).

In summary, Apixaban has comparable outcomes to enoxaparin for extended prophylaxis after radical cystectomy. This may provide an oral alternative for patients. Further research regarding cost analysis and patient compliance is requisite especially given the soaring costs of health care in the US.

Presented by: Shreya Lamba, BS, Saint Louis University School of Medicine, St. Louis, MO

Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological Association Annual Meeting, September 6-10, 2022, Coronado, CA

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