Enoxaparin After Pancreaticoduodenectomy for Pancreatic Cancer: Prescription Patterns and Outcomes

Abstract

Introduction: Patients undergoing abdominal operations for cancer should receive deep vein thrombosis (DVT) prophylaxis with enoxaparin for 28 days. This study aimed to determine prescription patterns in the United States, and the effect of enoxaparin on developing DVT or pulmonary embolism (PE) following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). Methods: Using Mariner (Pearldiver, Inc.), a national claims database, we identified patients undergoing pancreaticoduodenectomy for PDAC between 2010-2020. Patients taking anticoagulants or with history of DVT/PE were excluded. Logistic regression was used to 1) determine the effect of enoxaparin on developing a DVT/PE within 30 days of pancreaticoduodenectomy and 2) identify predictors of receiving an enoxaparin prescription. Results: 4146 patients underwent pancreaticoduodenectomy for PDAC. 65 patients (1.5%) developed DVT/PE within 30 days, with mean time to DVT/PE 16 days. 234 (5.6%) received a prescription for enoxaparin. Only one patient with enoxaparin prescription developed a DVT/PE (0.4%) Enoxaparin prescription demonstrated decreased odds of DVT/PE (OR=0.21,95%CI=0.05-0.85). After adjusting for age, sex, and comorbidities, enoxaparin was still associated with decreased odds of DVT/PE (OR=0.21,95%CI=0.03-0.69). Tobacco use was associated with increased odds of DVT/PE (OR=1.98,95%CI=1.16-3.35). Patients in the South were less likely to receive enoxaparin (OR=0.40,95%CI=0.29-0.57) compared to the Midwest. The odds of receiving enoxaparin increased over time (table 1). 2% of patients received enoxaparin in 2010, compared to 19% in 2020. Conclusions: Enoxaparin prescription following pancreaticoduodenectomy for PDAC is associated with decreased odds of developing DVT/PE. Prescription practices are increasing over time. Adherence to these guidelines can reduce DVT/PE in this patient population.Tabled 1YearOdds Ratio95% Confidence Interval20101(Reference)20164.211.72 – 12.6120175.702.39 – 16.8820186.302.66 – 18.5420198.183.51 – 23.88202015.916.12 – 49.54 Open table in a new tab