Adherence to apixaban for extended thromboprophylaxis after major abdominal or pelvic surgery for cancer: A prospective cohort study

Abstract

Background: Due to lack of data, direct oral anticoagulants are not considered by guidelines for venous thromboembolism (VTE) prophylaxis after cancer surgery.Adherence to low-molecular-weight heparin injections in this setting is sometimes poor.Aim: Analysis of adherence to oral apixaban for extended thromboprophylaxis.Methods: Consecutive patients discharged after major surgery for abdominal/pelvic cancer and considered eligible for extended prophylaxis were offered apixaban 2.5 mg twice daily. Primary outcomes were adherence metrics-proportion of prescriptions filled, persistence (not prematurely discontinued), proportion of days covered (PDC) based on apixaban pill counts, and modified Morisky medication adherence scale at Days 28-30. Secondary outcomes were bleeding, VTE, and serious adverse events until Day 90.Results: We included 53 patients, 51 were analyzed. Of 45 patients with prescriptions all had it filled (95% confidence interval [CI], 92%-100%). Persistence was 98% (95% CI, 90%-100%). PDC was ≥80% for 48 patients (94%; 95% CI, 84%-99%). We found good adherence (0/6 answers "yes") in 75% and moderate (1/ 6 answers "yes") in 25%. No major bleed or VTE occurred while on apixaban. Conclusion:Our results support good adherence with apixaban for VTE prophylaxis up to 28 days after major abdominal or pelvic cancer surgery.

Persistent underuse of extended venous thromboembolism prophylaxis in patients undergoing major abdominal cancer operations

“…While we did not evaluate barriers to prescription, studies have reported lack of insurance, inability to afford medication, and requiring additional insurance authorization as significant hurdles 20 . Patient adherence, especially around performing self‐injections, are another source of concern among prescribing providers 20 . Further studies should look to understand barriers specific to the Medicare population and to understand patient and provider perspectives that limit extended VTE prophylaxis despite the reported benefits.…”

“…Our findings highlight the need for addressing patient and provider‐specific barriers that impede extended VTE prophylaxis prescription. While we did not evaluate barriers to prescription, studies have reported lack of insurance, inability to afford medication, and requiring additional insurance authorization as significant hurdles 20 . Patient adherence, especially around performing self‐injections, are another source of concern among prescribing providers 20 .…”

Direct Oral Anti-Coagulants Continue to Bud into Gynecological Cancer-Thrombosis Prevention

“…Adherence to DOACs perioperatively and patient satisfaction are rated higher of oral anticoagulants compared to SC low molecular weight heparin. 11 When comparing apixaban to low molecular weight heparin for postoperative prophylaxis, patient satisfaction was significantly greater in the apixaban group with regard to ease of administration and pain associated with the medication which, aiming for a patient -centered practice, is highly desirable for a patient recovering from major surgery. 8 Although DOACs are becoming increasingly desirable as evidence-based alternative in oncologic surgery thrombosis prevention, this task is still undone.…”