EP966 - Safety and Efficacy of Rivaroxaban for Extended VTE Thromboprophylaxis in Patients Undergoing Colorectal Surgery

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Purpose/Background: Venous thromboembolism (VTE) is a significant source of morbidity and mortality in surgical patients, and colorectal surgery patients have an increased risk of postoperative VTE. Current ASCRS Clinical Consensus Guidelines recommend all patients who undergo abdominal surgery for cancer should receive extended-duration VTE prophylaxis (eVTEP) for four weeks. Traditionally, enoxaparin has been utilized, but PROLAPS II clinical trial highlighted a reduced incidence of postoperative VTE in patients receiving rivaroxaban. We aim to assess the incidence of VTE in postoperative colorectal surgery patients after transitioning from enoxaparin to rivaroxaban as eVTEP.

Methods/Interventions: Utilizing the NSQIP database, this retrospective cohort study included patients 18 years of age and older at UKMC who were treated with eVTEP in the first 30 days after colorectal surgery, including colectomy, or proctocolectomy from 01/01/2023 to 06/30/2024. Our academic center has historically used enoxaparin for extended VTE prophylaxis and has recently transitioned to rivaroxaban on 01/01/2024. The primary endpoint includes assessing incidence of VTE, including deep venous thrombosis (DVT), central venous thrombosis and pulmonary embolus (PE) in the first 30 days after colorectal surgery. Clinical information such as procedure(s) done, length of stay, diagnosis, number of blood transfusions, readmission rates and complications for the index hospital stay will be recorded. We conducted an unpaired t-test assessing VTE and outcomes associated with extended VTE prophylactic medications.

Results/Outcomes: Our study included a total of 400 patients with 305 receiving enoxaparin and 95 receiving rivaroxaban as eVTEP. Of the patients receiving enoxaparin, 8 were determined to have postoperative VTEs with two patients developing pulmonary embolisms. There were two patients receiving rivaroxaban who developed a postoperative DVT and none were determined to have a PE. These results reveal no statistically significant difference between the rates of VTE (enoxaparin 2.6%, rivaroxaban 2.1%, p=0.77) using either medication (Figure 1). Similarly, the outcomes of the percentage of patients requiring a postoperative blood transfusion (9.8% vs 8.4%, p= 0.68), and 30 day readmission (7.9% vs 7.1%, p=0.87) were not statically significant between enoxaparin and rivaroxaban. Hospital length of stay (LOS) was statistically significant with longer LOS among the enoxaparin group (7.7 vs 6.1 days, p=0.01).

Conclusion/Discussion: The data reveals similar incidences of VTEs among the two cohorts and supports the utilization of either medication with similarly low rates of adverse bleeding events or readmissions. The oral administration of rivaroxaban provides the opportunity for easier administration of VTE prophylaxis compared to intramuscular enoxaparin administration. The benefit of oral administration of rivaroxaban may provide increased compliance among patients and increased patient satisfaction postoperatively with the benefit of low risk of VTE.