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Session: ePoster: Quality and Cost 1 (Sun8)

EP360 - Patient Adherence to Extended Venous Thromboprophylaxis After Colorectal Surgery

Sunday, May 11, 2025
9:16 AM – 9:21 AM PT
Location: Monitor 9, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Ian Seward, MD

    General Surgery Resident
    University of Vermont Medical Center
    Burlington, VT, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • JC

    Jennifer G. Chen, BA, MS

    Medical Student
    University of Vermont Larner College of Medicine
    South Burlington, Vermont, United States

    Disclosure information not submitted.

  • PC

    Peter Cataldo, MD

    Professor of Surgery
    Larner College of Medicine
    Stowe, Vermont, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • JM

    Jesse Moore, MD FASCRS FACS

    Associate Professor of Surgery
    Univ of Vermont Medical Center
    Burlington, Vermont, United States

    Disclosure information not submitted.

  • KE

    Krista Evans, MD

    Associate Professor
    Larner UVM College of Medicine
    Burlington, Vermont, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • JD

    Jeremy Dressler, MD

    Assistant Professor
    University of Vermont Department of Surgery
    Burlington, Vermont, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Ian Seward, MD: This individual has no financial relationships with ineligible companies.
Peter Cataldo, MD: This individual has no financial relationships with ineligible companies.
Krista Evans, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Post-operative venous thromboembolism (VTE) is a well described complication for patients undergoing colonic resection, especially for those diagnosed with cancer or inflammatory bowel disease. Furthermore, recent data suggest that the VTE risk period extends beyond the post-operative hospital stay. To address this, both the 2018 and 2023 ASCRS Clinical Practice Guidelines recommend consideration of extended post-operative VTE prophylaxis in surgical patients. Low molecular weight heparin (LMWH) is most often prescribed as it has been well studied, but patient adherence with injectable anticoagulants is low. Oral anticoagulation has been used as prophylaxis in other settings, but studies in post-operative colorectal surgical patients are limited. Our study investigates oral thromboprophylaxis adherence rates in the patients undergoing elective colorectal resection.

Methods/Interventions: From February 2024 through August 2024 patients that underwent elective colonic or small bowel resection were stratified based on their post-operative Caprini scores. Those patients with scores greater than or equal to 5 were automatically prescribed oral thromboprophylaxis, 2.5 mg apixaban twice daily, for a total of 28 days. One month post discharge, patients were administered a phone survey to assess adherence and post-operative outcomes.

Results/Outcomes: 72 patients underwent elective colonic or small bowel resection during the study period. Patients were included in the study if they had a post-operative Caprini score >=5 and were not on chronic anticoagulation. 46 patients met inclusion criteria, of these patients, 38 underwent colon or rectal resection alone (83%), 7 underwent colonic and small bowel resection (15%) and 1 patient underwent small bowel resection, (2%). 21 out of the 46 patients responded to the telephone survey, with an overall response rate of 45%. All 21 patients reported that they were discharged with the medication, filled their prescription and took the medication as prescribed. No patients reported that they experienced side effects regarding unexpected bleeding or clotting.

Conclusion/Discussion: Based on survey data, patient adherence is very high to an extended VTE prophylaxis regimen using oral apixaban following elective colorectal surgery. Reasons for high adherence are likely related to an easier, less painful, route of administration. No significant bleeding or clotting events occurred in our study population, however given our small sample size, relative safety and efficacy cannot be determined. Further investigation is warranted to compare efficacy and adherence between oral apixaban and injectable LMWH.