The efficacy and safety of direct oral anticoagulants compared with low-molecular-weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft-tissue sarcoma Journal Article
| Authors: | LiBrizzi, C. L.; Agarwal, A. R.; Chiu, A. K.; Morris, C. D.; Thakkar, S. C.; Levin, A. S. |
| Article Title: | The efficacy and safety of direct oral anticoagulants compared with low-molecular-weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft-tissue sarcoma |
| Abstract: | Introduction: The incidence of postoperative venous thromboembolism (VTE) and wound complications is greater after sarcoma resection. We sought to identify differences in postoperative VTE and bleeding complications with direct oral anticoagulants (DOACs) versus low-molecular-weight heparin (LMWH) following resection of lower extremity primary bone or soft tissue sarcoma. Methods: We retrospectively identified 2083 patients from the PearlDiver database who underwent resection of primary bone or soft tissue sarcoma of the lower extremity from January 2010 to October 2021 and prescribed LMWH or DOAC within 90-days postoperatively. The primary outcomes were comparison of postoperative incidence and odds of deep venous thrombosis (DVT), pulmonary embolism (PE), and bleeding complications within 90-days following resection. Results: Patients prescribed DOACs had a greater odds of DVT (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.06–2.41; p = 0.024) and PE (OR: 3.38; 95% CI: 1.96–5.86; p < 0.001) within 90-days following resection of bone sarcoma when compared with the LMWH cohort. Patients undergoing resection of soft tissue sarcomas also had greater odds DVT (OR: 1.65; 95% CI: 1.09–2.49; p = 0.016) and PE (OR: 2.62; 95% CI: 1.52–4.54; p < 0.001) in the DOAC cohort. There was no difference in the odds of bleeding complications. Conclusion: This study demonstrated an increased incidence and odds of VTE, but not bleeding complications, when using DOACs versus LMWH after primary bone or soft tissue sarcoma resection. Level of Evidence: Level III. © 2023 Wiley Periodicals LLC. |
| Keywords: | adult; controlled study; middle aged; cancer surgery; excision; primary tumor; retrospective studies; major clinical study; postoperative period; drug efficacy; drug safety; comparative study; anemia; bleeding; incidence; cohort analysis; deep vein thrombosis; data base; retrospective study; patient identification; sarcoma; lung embolism; postoperative complication; postoperative complications; pulmonary embolism; thrombosis; prophylaxis; comorbidity; anticoagulants; blood transfusion; heparin; soft tissue sarcoma; embolism; wound complication; soft tissue neoplasms; soft tissue tumor; enoxaparin; low molecular weight heparin; venous thromboembolism; anticoagulant agent; apixaban; argatroban; dalteparin; rivaroxaban; tinzaparin; bone sarcoma; lower extremity; clinical outcome; demographics; heparin, low-molecular-weight; thrombosis prevention; thrombophlebitis; dabigatran; thromboprophylaxis; humans; human; male; female; article; edoxaban; lower limb; betrixaban; doac; embolism prevention |
| Journal Title: | Journal of Surgical Oncology |
| Volume: | 129 |
| Issue: | 3 |
| ISSN: | 0022-4790 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2024-03-01 |
| Start Page: | 537 |
| End Page: | 543 |
| Language: | English |
| DOI: | 10.1002/jso.27519 |
| PUBMED: | 37985245 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
