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P88. Prospective evaluation of safety and patient satisfaction with apixaban versus low molecular weight heparin for extended prophylaxis after cancer surgery

Friday, March 6, 2026
3:26 PM - 3:33 PM MST
Location: 105A-C
Introduction: Current guidelines recommend low molecular weight heparin (LMWH) for extended postoperative prophylaxis for venous thromboembolism (VTE) in cancer surgery patients. Some specialties use direct oral anticoagulants (DOACs) as an alternative to subcutaneous LMWH with improved patient satisfaction. This study aimed to evaluate patient satisfaction and safety with DOAC use for extended prophylaxis in cancer surgery patients.


Methods:

This single-center prospective cohort study enrolled adult patients from July 2023 to April 2025 who underwent gastrointestinal, soft tissue, and endocrine cancer surgery and qualified for 28 days of VTE prophylaxis. As a quality improvement study using two approved forms of prophylaxis, informed consent for medication administration was waived. The study was conducted in two sequential phases: (1) standard-of-care LMWH and (2) apixaban 2.5mg oral twice daily. A survey was sent on postoperative day 28 to assess the primary outcomes of compliance and satisfaction. Each phase was completed after an estimated 200 survey responses. Secondary outcomes included bleeding and thrombosis complications within 90 days and out-of-pocket cost. 



Results:

In total, 677 patients met study criteria, including 280 (41.4%) receiving LMWH and 397 (58.6%) apixaban. Surveys were completed by 411 patients (60.7%): 186 (66.4%) for LMWH and 225 (56.7%) for apixaban. Patients reported higher overall satisfaction with apixaban [median score 10 (IQR 8-10) vs 9 (6-10), p=0.005].  Although more patients missed an apixaban dose (37.2% vs 23.2%, p=0.003), the median number of missed doses for both was clinically insignificant at 2 (IQR 1-3, p=0.81). Patients reported less pain, bruising, and anxiety, and greater ease of administration with apixaban (all p< 0.001). 



There was no difference in total complications between apixaban and LMWH (4.0% vs 4.3%, p >0.99), but fewer major bleeding events ( >2 g/dl decrease in hemoglobin or requiring intervention) occurred in the apixaban arm (0.5% vs 2.5%, p=0.038). There were no differences in rates of minor bleeding (1.8% vs 0.7%, p=0.32), VTE (1.0% vs 0.7%, p >0.99), ER visits (2.5% vs 1.4%, p=0.48), or readmissions (1.3% vs 1.8%, p=0.75). Mean cost was higher for LMWH ($55.30 vs $30.20, p=0.001), but this metric was limited by the availability of drug coupons for apixaban.



Conclusions: After cancer surgery, extended postoperative VTE prophylaxis with oral apixaban was a safe and cost-effective alternative to standard-of-care LMWH. Apixaban was associated with improved patient satisfaction. 

Learning Objectives:

  • Low molecular weight heparin and apixaban are both safe options for extended venous thromboembolism prophylaxis after major cancer surgery, with similar low rates of complications.
  • The use of apixaban for extended venous thromboembolism prophylaxis after major cancer surgery is associated with improved patient satisfaction, compared to low molecular weight heparin.