# Comparison of Efficacy and Safety of Rivaroxaban, Heparin, and Enoxaparin in Preventing Thrombosis in Gynaecologic Oncology Surgeries: Thromboprophylaxis in Gyn-oncology Surgery

## TL;DR

This study compares the effectiveness and safety of three blood thinners in preventing blood clots after gynecologic cancer surgeries.

## Contribution

The study provides preliminary evidence on the comparative safety and efficacy of rivaroxaban, heparin, and enoxaparin in gynecologic oncology surgery patients.

## Key findings

- Rivaroxaban was associated with higher intraoperative transfusion rates compared to heparin and enoxaparin.
- Rivaroxaban caused more short-term peripheral edema than the other two drugs.
- No significant differences were found in most other outcomes between the groups.

## Abstract

Background: Background: Venous thromboembolism (VTE) is a frequent and
potentially serious complication following gynecologic oncology surgeries.
Anticoagulants such as heparin, enoxaparin, and rivaroxaban are commonly
used for thromboprophylaxis; however, their comparative efficacy and safety
remain uncertain in this patient population.

Materials and Methods: This pilot randomized controlled trial included 85
patients undergoing gynecologic oncology surgery, randomly assigned to
receive enoxaparin (n=25), heparin (n=30), or rivaroxaban (n=30).
Randomization was performed using block randomization (block size=3) with
allocation concealment and double blinding of patients and outcome
assessors. The trial was registered in the Iranian Registry of Clinical
Trials (IRCT20151020024625N19) and approved by the Ethics Committee of
Semnan University of Medical Sciences (IR.SEMUMS.REC.1402.223). Baseline
data included age, BMI, cancer type, surgical procedure, and history of
vascular events. Outcomes comprised transfusion requirement, dyspnea, chest
pain, peripheral edema, lower limb pain, bleeding, infection, hematoma,
recovery, and mortality. Data analysis was performed using SPSS v.22 (IBM
Corp., Armonk, NY, USA).

Results: Fourteen patients (16.5%) required intraoperative transfusion, with
a significantly higher rate in the rivaroxaban group (33.3%) compared to
enoxaparin (8.0%) and heparin (6.7%) (P=0.010). Peripheral edema was also
more common with rivaroxaban (16.7%) than with heparin (3.3%) or enoxaparin
(0%) (P=0.046). Other outcomes showed no significant between-group
differences (all P0.05).

Conclusions: Rivaroxaban use was linked to increased intraoperative
transfusion and short-term edema compared to heparin and enoxaparin. Larger
multicenter trials are warranted to confirm these preliminary safety and
efficacy findings.