Apixaban Versus Enoxaparin for Venous Thromboembolism Prophylaxis in Colorectal Surgery

Guidelines recommend postoperative venous thromboembolism (VTE) prophylaxis in colorectal cancer patients, as well as others at high risk of VTE. However, compliance, especially with injectable prophylaxis strategies remains challenging for patients and providers. Here, we evaluate the efficacy of apixaban versus enoxaparin in patients undergoing colorectal surgery (CRS) for postoperative VTE prophylaxis.

This is a retrospective study of institutional data conducted at a tertiary referral center. Data retrieved were from cases between January 2018 and May 2023. 1008 patients were included, 388 received enoxaparin, 620 received apixaban following discharge from abdominal or combined abdominal-perianal CRS. Patients on anticoagulation before surgical intervention were excluded as were those undergoing isolated stoma reversal or creation. The primary outcome was VTE in the 30 ds following discharge from CRS. Secondary outcome was bleeding, requiring either transfusion, intervention or readmission.

Rates of VTE are low in both groups, but significantly higher in those who received enoxaparin than those who received apixaban (1.29% versus 0.16%, P = 0.023). Those receiving apixaban were significantly older, had longer operative times, underwent more minimally invasive procedures, and were more likely to have cancer (P < 0.01 for all instances). Postoperative bleeding rates did not differ between groups.

Patients undergoing CRS are effectively managed with apixaban as postdischarge VTE prophylaxis. VTE rates were lower in the apixaban group than in the enoxaparin group; additional randomized prospective trials are needed to validate this finding.