Apixaban vs Enoxaparin for Preventing Postoperative Thromboembolic events in Women Undergoing Surgery for Gynecologic Cancers: A Randomized Clinical Trial Study

Abstract

Background: Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism, presents a significant clinical risk for women undergoing surgical intervention for gynecologic malignancies. Enhanced prophylactic strategies are vital to mitigating these complications. This study evaluates the efficacy and safety of oral apixaban compared to subcutaneous enoxaparin for postoperative VTE prevention in this high‑risk population. Materials and Methods: This randomized clinical trial was conducted from March 2022 to March 2023. One hundred eligible patients undergoing gynecologic cancer surgery were randomized to receive either oral apixaban (2.5 mg twice daily) or subcutaneous enoxaparin (40 mg daily). The primary endpoints included the incidence of thromboembolic events and bleeding complications, monitored up to 12 weeks postoperatively. Results: This cohort consisted of 48 patients in the apixaban group and 52 in the enoxaparin group. Postoperative complications included vaginal bleeding (8.32% apixaban vs. 3.85% enoxaparin), hematoma (2.15% apixaban vs. 3.85% enoxaparin), and ecchymosis (6.37% apixaban vs. 9.62% enoxaparin). None of these differences achieved statistical significance (p > 0.05). Both groups demonstrated comparably high levels of treatment adherence and patient satisfaction. Conclusions: Apixaban and enoxaparin demonstrated comparable efficacy and safety profiles in preventing postoperative VTE following gynecologic cancer surgery. Given its oral administration route, apixaban may serve as a feasible alternative to enoxaparin, potentially enhancing patient compliance. Further large‑scale studies are warranted to validate these findings.