Avoiding Risks of Thrombosis and bleeding in Surgery

Each year, millions of patients who undergo abdominal or pelvic cancer surgery incur the risk of venous thromboembolism (VTE). Because pharmacological prophylaxis decreases the risk of VTE, but increases the risk of bleeding, and because knowledge of these risks is uncertain, both clinical practice and guideline recommendations vary widely. The ARTS trial will be the first to evaluate the effectivenessa and safety of apixaban, which is a direct oral anticoagulant (DOAC) versus no anticoagulant in urologic, abdominal and gynecologic surgery patients. The trial will have three possible outcomes, any of which will lead to changes in clinical care worldwide. If the trial shows that apixaban is of clear net benefit, abdominal or pelvic surgery patients will change from use of low molecular weight heparins to the far less burdensome DOACs. If the trial instead shows that anticoagulation performs no better than no anticoagulation, the result will be a decrease in the use of anticoagulation in these patients, reduction of bleeding complications and more efficient use of scarce resources. The ARTS trial may show a close balance between risks and benefits. If so, it will strengthen the case for individualized thromboprophylaxis for patients deemed to be at high risk for VTE.