7893 Venous Thromboembolism Prophylaxis after Hysterectomy for Endometrial Malignancy in Class III Obesity: Patient Preferences and Outcomes

Abstract

<h3>Study Objective</h3> This study assessed patient preference between two anticoagulants for postoperative venous thromboembolism (VTE) prophylaxis following hysterectomy for endometrial intraepithelial neoplasia (EIN) or grade 1 endometrioid adenocarcinoma in patients with class III obesity. <h3>Design</h3> Prospective quality improvement study. <h3>Setting</h3> Canadian urban, tertiary-care hospital. <h3>Patients or Participants</h3> All patients undergoing hysterectomy for EIN or grade 1 endometrial cancer with a body mass index (BMI) ≥ 40 between February 2021 and March 2022 who were eligible for extended postoperative anticoagulation, which is recommended in this population due to the high risk of VTE. <h3>Interventions</h3> Patients were provided with information about dalteparin, an injectable low-molecular weight heparin, and apixaban, a direct oral anticoagulant, prior to surgery. Postoperatively, patients were surveyed about their anticoagulation preference and discharged home with their preferred anticoagulant. Patients were followed up six weeks postoperatively to assess for medication adherence and adverse events. <h3>Measurements and Main Results</h3> 42 patients were included in the study with a mean BMI of 48.7 ± 7.32 kg/m². One patient had an abdominal hysterectomy, all others underwent robotic hysterectomy. Significantly more patients chose apixaban over dalteparin (30/42, p = 0.008). Route of administration was the most common reason for choosing apixaban, with doctor recommendation and medication cost as other commonly cited reasons. For patients choosing dalteparin, the available evidence and known efficacy in people weighing more than 100 kgs were the main reasons for selection. At 6 weeks post-hysterectomy there were no significant differences in rates of medication adherence, postoperative VTE, or clinically relevant bleeding between the groups. <h3>Conclusion</h3> The majority of patients with class III obesity selected apixaban over dalteparin for postoperative VTE prophylaxis. Although apixaban has less data supporting its use in this population, there were no adverse events in this study. Both anticoagulation options should be offered as this supports patient values and preferences in informed decision making and may improve accessibility.