Comparative analysis of apixaban vs. enoxaparin for thromboprophylaxis after radical cystectomy

A single-center, observational, before-after study

Authors

  • Cory S. Macklin University of British Columbia
  • Gabrielle Reznik University of British Columbia
  • Martin E. Gleave University of British Columbia
  • Miles P. Mannas University of British Columbia
  • Peter C. Black University of British Columbia
  • Marie-Pier St-Laurent University of British Columbia

DOI:

https://doi.org/10.5489/cuaj.9312

Keywords:

apixaban vs. enoxaparin, thromboprophylaxis, radical cystectomy, bladder cancer

Abstract

INTRODUCTION: Radical cystectomy (RC) is the standard treatment for muscle-invasive and select high-risk non-muscle-invasive bladder cancer. Venous thromboembolism (VTE) is a common and preventable postoperative complication. Extended thromboprophylaxis with low-molecular-weight heparin, such as enoxaparin, is recommended, but direct-acting oral anticoagulants like apixaban are a possible alternative. This study evaluated the safety and efficacy of apixaban compared to enoxaparin for extended postoperative thromboprophylaxis following RC.

METHODS: A single-center, observational, before-after study of RCs performed between October 2021 and August 2024 was conducted. Patients receiving 28 days of post-discharge thromboprophylaxis with either enoxaparin or apixaban were included. The primary outcome was postoperative VTE within 30 days. Secondary outcomes included 90-day postoperative VTE, 30-day post-discharge emergency room (ER) visits, readmissions, complications such as bleeding, and 90-day postoperative mortality.

RESULTS: A total of 102 patients who received enoxaparin and 83 patients who received apixaban for VTE thromboprophylaxis were included. No significant differences were found in 30-day postoperative VTE rates (0 [0%] apixaban vs. 2 [2%] enoxaparin, p=0.5), 90-day VTE rates, 90-day overall survival, or 30-day post-discharge ER visits, readmissions, or hemorrhagic complications (p>0.05).

CONCLUSIONS: Apixaban appears to be a safe and effective alternative to enoxaparin for extended postoperative VTE prophylaxis following RC for bladder cancer.

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Published

2025-07-28

How to Cite

Macklin, C. S., Reznik, G., Gleave, M. E., Mannas, M. P., Black, P. C., & St-Laurent, M.-P. (2025). Comparative analysis of apixaban vs. enoxaparin for thromboprophylaxis after radical cystectomy: A single-center, observational, before-after study. Canadian Urological Association Journal, 19(8), 236–41. https://doi.org/10.5489/cuaj.9312

Issue

Vol. 19 No. 8 (2025): CUAJ August

Section

Original Research

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