Efficacy and safety of enoxaparin in Japanese patients undergoing curative abdominal or pelvic cancer surgery: Results from a multicenter, randomized, open-label study

Abstract

Background Enoxaparin sodium (enoxaparin) is used worldwide for the prevention of venous thromboembolism (VTE). Registration trials of enoxaparin have been conducted primarily in Caucasian populations, and its preventive use in Japanese patients has yet to be established. To address this, we evaluated the efficacy and safety of postoperative enoxaparin in Japanese patients undergoing surgery for abdominal cancer. Methods This multicenter, open-label study randomized 151 Japanese patients undergoing curative surgery for abdominal cancer to enoxaparin 20 mg twice daily for 14 days, started 24–36 hours after surgery (n = 113) or intermittent pneumatic compression (IPC) as a reference (n = 38). IPC was performed at least once in both groups between randomization and surgery. The primary efficacy endpoint was the incidence of VTE in the modified intention-to-treat (mITT) population. The primary safety outcome was the incidence of any bleeding during treatment and follow-up. Results Incidence of VTE was 1.2% (95% CI, 0.03–6.53%) (1/83 patients) in the enoxaparin group and 19.4% (95% CI, 7.45–37.47%) (6/31 patients) in the IPC group. In the safety population, 10/109 patients in the enoxaparin group (9.2%; 95% CI, 4.49–16.23%) and 3/38 patients in the IPC group (7.9%; 95% CI, 1.66–21.38%) experienced a bleeding event. There were no cases of fatal bleeding or bleeding into any critical organ. Conclusions These favorable efficacy and safety data support the use of enoxaparin (20 mg twice daily for 14 days started 24–36 hours after surgery) in Japanese patients undergoing abdominal or pelvic cancer surgery.