Outcomes from a prospectively implemented protocol using apixaban after robot-assisted radical cystectomy

Area of Science:

• Urology
• Cardiovascular Medicine
• Pharmacology

Background:

• Robot-assisted radical cystectomy (RARC) is a complex procedure associated with a risk of venous thromboembolism (VTE).
• Enoxaparin has been the standard injectable anticoagulant for VTE prophylaxis post-RARC.
• The oral anticoagulant apixaban offers a potential alternative for thromboprophylaxis.

Purpose of the Study:

• To compare the safety and efficacy of oral apixaban versus injectable enoxaparin for VTE thromboprophylaxis.
• To evaluate VTE incidence, bleeding complications, and other postoperative outcomes in RARC patients receiving either apixaban or enoxaparin.

Main Methods:

• Retrospective review of prospectively collected data from RARC patients (2018-2022).
• Two groups: post-October 2021 receiving 21-day oral apixaban, and pre-October 2021 receiving daily enoxaparin.
• Primary outcome: symptomatic VTE within 90 days post-RARC. Secondary outcomes: bleeding, complications, readmission, mortality within 30 days.

Main Results:

• 124 patients received apixaban and 250 received enoxaparin.
• Overall VTE incidence was 1.6% in the apixaban group vs. 3.2% in the enoxaparin group (P=0.5).
• No statistically significant differences in VTE rates were observed between apixaban and enoxaparin, even after risk stratification.

Conclusions:

• Apixaban and enoxaparin showed comparable safety and efficacy in preventing VTE after RARC.
• Apixaban is a safe and effective option for VTE prophylaxis in patients undergoing RARC.
• Further prospective studies may be warranted to confirm these findings.