The Use of Apixaban for Postoperative Venous Thromboembolism Prophylaxis in Gynecologic Cancer

Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is an important source of morbidity, mortality, and healthcare cost following open abdominal surgery. 1 Surgery is associated with a sixfold increased likelihood of VTE. 2 A diagnosis of cancer also increases one's risk via multiple mechanisms, including direct tumor compression causing venous stasis, release of procoagulation factors, and receipt of prothrombogenic chemotherapies. 3Taken together, these data put into context why patients undergoing open surgery for gynecologic cancer are at significant risk of VTE in the postoperative setting, with risk reported to be as high as 25%. 4 For this reason, extended VTE prophylaxis for 28 days is now recommended for high-risk patients with cancer undergoing laparotomy. 5,6Gynecologic oncologists have typically utilized enoxaparin in this setting, which is injected subcutaneously once daily, given its established efficacy and safety. 7][10] One randomized trial in gynecologic oncology patients found no difference in bleeding events or VTE rates for apixaban versus enoxaparin, and those who This article refers to: