Oral versus Injectable Anticoagulants- a Prospective Study Evaluating Apixaban as a Patient-Friendly Alternative to Enoxaparin for DVT Prevention in Orthopaedic Trauma

Abstract

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in hospitalized orthopaedic and trauma patients. Its multifactorial pathogenesis—venous stasis, endothelial injury, and hypercoagulability (Virchow’s triad)¹—necessitates timely prophylaxis. Low molecular weight heparins (LMWH) have been standard, but limitations such as injection-site issues and bleeding risks have led to increased use of direct oral anticoagulants (DOACs) like apixaban²˒⁴. Apixaban offers oral administration, predictable pharmacokinetics, and minimal monitoring². Evidence suggests it is as effective as LMWH with potentially lower bleeding risk³˒⁵. In trauma patients, anticoagulation must be tailored due to variable bleeding risk⁵. This study compares apixaban and enoxaparin in hip fracture patients to assess safety and effectiveness.

Methods: A prospective comparative study was conducted over 18 months at a tertiary orthopaedic centre. A total of 120 patients aged >45 years with fractures around the hip joint were enrolled and divided into two equal groups receiving either apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously once daily) for DVT prophylaxis. Pre and post-intervention assessments included coagulation profile (PT, aPTT, INR) and Doppler studies. Safety was assessed through patient-reported bleeding and side effects; effectiveness was assessed through Doppler-confirmed absence of DVT.

Results: There were no statistically significant changes in PT, aPTT, or INR in either group post-intervention (p > 0.05). No episodes of DVT or major bleeding were reported in either group during the early postoperative period (~11th postoperative day). Patients in the apixaban group preferred oral administration over subcutaneous injection. Both groups demonstrated comparable safety and effectiveness profiles for DVT prophylaxis in the early postoperative period.

Conclusion: Apixaban was found to be as effective and safe as enoxaparin for DVT prophylaxis in patients undergoing orthopedic procedures for hip fractures. The convenience of oral administration favored patient preference, supporting apixaban’s role as a viable alternative to enoxaparin. Larger randomized controlled trials with longer follow-up are recommended to confirm these findings and evaluate long-term outcomes.