eP349 - Safety and Efficacy of Apixaban versus Enoxaparin Prolonged Thromboprophylaxis After Surgery for Colorectal Cancer

Purpose/Background: Colorectal cancer (CRC) is associated with increased risk of postoperative venous thromboembolic events (VTE) leading to short- and long-term morbidity. Current guidelines recommend extended duration thromboprophylaxis using low molecular weight heparin (LMWH). Studies have shown that the rate of adherence to this recommendation is low probably due to patient inconvenience with injections and financial hurdles. Oral anticoagulation(AC) could be an alternative option, however the efficacy and safety is largely unexplored after CRC oncological resection.Methods/Interventions: This is a retrospective study from a single institution. The study included all CRC patients who underwent oncological resection from 2022 to 2023. We excluded patients who were on AC prior to surgery, had contraindications to AC, previous VTE, or underwent local transanal excision. All patients were administered 5000 IU unfractionated heparin starting 2 hours before surgery then every 8 or 12 hours postoperatively till discharge. Patients were prescribed either apixaban or enoxaparin for 4 weeks postoperatively. Chi square test was used for univariate analysis and multinomial logistic regression test was used for multivariate analysis.Results/Outcomes: Study included 97 patients; 52 received apixaban, 16 received enoxaparin and 29 didn’t receive any prolonged thromboprophylaxis(PTP). The incidence of VTE at 3 months was 10%, 2% and 0% in the non-PTP, apixaban and enoxaparin group; respectively. VTE was significantly higher in the non-PTP group compared to the PP group (p=0.04). There was no difference among the 3 groups in the multivariate model. The rate of bleeding after discharge was 0%, 2% and 12% in the non-PTP, apixaban and enoxaparin group;respectively. 1 and 2 patients had bleeding per rectum within the first week after discharge in the apixaban and enoxaparin group;respectively. All bleeding resolved spontaneously after stopping the apixaban or enoxaparin without need for transfusions or re-admissions. There was no statistical significant difference in bleeding rates. Except for the 3 patients with bleeding, all patients completed 4 weeks of PTP with no difference in compliance between both apixaban and enoxaparin groups.Conclusion/

Discussion: This study shows that apixaban could be a safe alternative to LMWH in prolonged thromboprophylaxis after CRC surgery. These results should be confirmed in larger-scale prospective, randomized clinical trials."Table 1

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