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

Authors

Christa L. LiBrizzi, Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Amil R. Agarwal, Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Anthony K. Chiu, Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Carol D. Morris, Division of Orthopaedic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Savyasachi C. Thakkar, Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Adam S. Levin, Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Document Type

Journal Article

Publication Date

11-20-2023

Journal

Journal of surgical oncology

DOI

10.1002/jso.27519

Keywords

DOAC; embolism; heparin; sarcoma; thromboprophylaxis; thrombosis

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.

APA Citation

LiBrizzi, Christa L.; Agarwal, Amil R.; Chiu, Anthony K.; Morris, Carol D.; Thakkar, Savyasachi C.; and Levin, Adam S., "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" (2023). GW Authored Works. Paper 3780.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3780

Department

School of Medicine and Health Sciences Student Works