Introduction: Anticoagulants are used prophylactically to prevent venous thromboembolism (VTE) in the perioperative period for patients undergoing surgery for gynecological cancer. However, they carry a substantial risk of bleeding. This meta-analysis aims to study the efficacy and safety of Apixaban and Rivaroxaban compared to the traditional Enoxaparin.

Methods: PRISMA guidelines were followed, and PubMed, Cochrane, and Google Scholar were searched using MeSH terms ‘gynecological cancer’ AND ‘DVT prophylaxis’ OR ‘thromboprophylaxis’ OR ‘Enoxaparin’ from January 2004 to December 2023. Five studies were included in analysis. Demography, type and duration of surgery, treatment efficacy, and safety data was extracted. The inter-study variance was calculated using the Der Simonian-Laird Estimator. Proportions and 95% Confidence Interval (CI) were extracted to compute pooled analysis using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.3.3).

Results: A total of 1797 patients from the five studies (Apixaban n=326, Rivaroxaban n=343, Enoxaparin n=1138) reporting the perioperative outcomes of Apixaban and Rivaroxaban versus Enoxaparin therapy were included, of which 2 were clinical trials (40%), and 3 were retrospective analyses (60%). The mean age for Apixaban and Rivaroxaban was 57.3 years, and the mean age for Enoxaparin was 59.1 years. The mean BMI for Apixaban, Rivaroxaban and Enoxaparin was 27.1. The pooled composite venous thromboembolism relative risk for Apixaban vs Enoxaparin was 0.64 (95% CI 0.22-1.89, 12=0%, p=1.00). The pooled composite VTE, the relative risk for Rivaroxaban vs. Enoxaparin, was 0.58 (95%CI 0.24-1.41, 12=0%, p=0.69). The pooled DVT relative risk for Apixaban vs Enoxaparin was 1.11 (95% CI 0.1-12.75, 12=75%, p=0.13). The pooled major bleeding relative risk for Rivaroxaban vs Enoxaparin was 4.31 (95% CI, 1.18-15.79, 12=0%, p=0.47). No pooled major bleeding relative risk for Apixaban vs. Enoxaparin could be calculated as only one study mentioned outcome.

Conclusions: Our analysis suggests that direct oral anticoagulants offer superior efficacy compared to Enoxaparin for preventing venous thromboembolism. However, Rivaroxaban is associated with a significantly higher risk of bleeding compared to Enoxaparin. Further clinical trials and randomized studies to evaluate the comparative effectiveness and safety of these anticoagulants in various patient populations are essential. Such studies are important for the development of comprehensive international guidelines for VTE management, ensuring optimal evidence-based treatment.

Disclosures

Winer:MDX: Consultancy.

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2024
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