Patient perspectives on post-operative direct oral anticoagulant for venous thromboembolism prevention in patients with gynecologic cancers undergoing laparotomy.

Background: Extended venous thromboembolism (VTE) prophylaxis is recommended for patients undergoing laparotomy for gynecologic cancers. The primary objective of this study was to evaluate patient satisfaction while our program transitioned from low molecular weight heparin (LMWH) to direct oral anticoagulant (DOAC) apixaban for extended VTE prophylaxis. Methods: Adult patients undergoing laparotomy for gynecologic malignancy in Alberta, Canada between April - December 2024 were considered for inclusion. The primary outcome was patient satisfaction, measured by the modified Anti-Clot Treatment Scale survey. Secondary outcomes included VTE incidence, major bleeding, and medication adherence. Results: 111 patients were considered for inclusion; 50 patients completed the survey, and 40 patients had both survey and corresponding clinical data. All patients received pre-operative anticoagulation. Upon hospital discharge, 9 patients received LMWH, and 41 received DOAC. No patients experienced a VTE, and 1 patient on DOAC experienced a major bleed. Patients taking DOAC for extended VTE prophylaxis reported significantly less difficulty following anticoagulation treatment, less concern regarding cost of medication, and required less help compared to LMWH. Conclusion: The use of DOAC for extended VTE prophylaxis was associated with high patient satisfaction, further supporting its use in this context.