ABSTRACT
Background: Venous thromboembolism (VTE) poses a significant risk following surgical resection of primary lower extremity bone or soft-tissue sarcoma. Direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) have emerged as effective prophylactic agents against VTE. However, comparative studies assessing their efficacy and safety specifically in this patient population are limited.
Aim: This study aimed to compare the efficacy and safety of DOACs with LMWH for VTE prophylaxis following surgical resection of primary lower extremity bone or soft-tissue sarcoma.
Methods: A retrospective cohort study was conducted, including patients who underwent surgical resection of primary lower extremity bone or soft-tissue sarcoma between April 2023 and March 2024. Patients were divided into two groups based on the type of VTE prophylaxis received: DOACs or LMWH. The primary outcomes assessed were the incidence of VTE events and major bleeding episodes. Secondary outcomes included minor bleeding events and all-cause mortality.
Results: A total of 120 patients were included in the study, with 70 receiving DOACs and 50 receiving LMWH for VTE prophylaxis. The incidence of VTE events was significantly lower in the DOAC group compared to the LMWH group (p < 0.05). Additionally, major bleeding episodes were similar between the two groups (p = 0.75). Minor bleeding events occurred more frequently in the LMWH group compared to the DOAC group (p < 0.05). There was no significant difference in all-cause mortality between the two groups (p = 0.60).
Conclusion: In patients undergoing surgical resection of primary lower extremity bone or soft-tissue sarcoma, DOACs demonstrate superior efficacy in preventing VTE events compared to LMWH, with similar rates of major bleeding and lower rates of minor bleeding. These findings support the use of DOACs as a safe and effective alternative for VTE prophylaxis in this patient population.
Keywords: Direct oral anticoagulants, low-molecular-weight heparin, venous thromboembolism, surgical resection, lower extremity, bone sarcoma, soft-tissue sarcoma, efficacy, safety.