建议在我们中心接受妇科癌症手术的患者服用最多 28 天的依诺肝素，以延长术后血栓预防 (EP)。基线调查显示 92% 的患者依从性较高，但强调了注射给药途径对患者体验的负面影响。在引入阿哌沙班作为 EP 的口服替代品后，我们的目标是通过减少 50% 的疼痛和瘀伤、提高 5% 的依从性以及降低自付费用来改善患者体验。在这项间断时间序列质量改进研究中，妇科癌症出院时，患者可以选择阿哌沙班（2.5 毫克，每日两次口服）或依诺肝素（40 毫克，每日一次皮下注射）。多学科团队负责项目设计、实施和评估。流程干预包括标准化订单、患者和护理团队教育计划。第 1 周和第 6 周进行电话调查，并绘制审计通知结果、流程和平衡措施。从 2022 年 8 月到 2022 年 10 月，连续纳入了 127 名患者。 84% 的人选择了阿哌沙班。调查回复率为74%。选择阿哌沙班的患者报告疼痛、瘀伤显着减轻，用药信心增强，药物负面影响较小（所有患者的 p < 0.0001）。依从性没有变化（92%）。支付低于 125 美元（阿哌沙班成本阈值）的患者比例从 45% 增加到 91%。出血和 VTE 事件没有差异。在 EP 中引入阿哌沙班与患者报告的质量指标的显着改善和经济毒性的降低相关，而对依从性或平衡指标没有影响。阿哌沙班是我们中心 EP 的首选抗凝剂。版权所有 © 2024 Elsevier Inc. 保留所有权利。

Patients undergoing gynecologic cancer surgery at our centre are recommended up to 28 days of enoxaparin for extended post-operative thromboprophylaxis (EP). Baseline survey revealed 92% patient adherence, but highlighted negative effects on patient experience due to the injectable route of administration. We aimed to improve patient experience by reducing pain and bruising by 50%, increasing adherence by 5%, and reducing out-of-pocket cost after introducing apixaban as an oral alternative for EP.In this interrupted time series quality improvement study, gynecologic cancer patients were offered a choice between apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously once daily) at time of discharge. A multidisciplinary team informed project design, implementation, and evaluation. Process interventions included standardized orders, patient and care team education programs. Telephone survey at 1 and 6 weeks and chart audit informed outcome, process, and balancing measures.From August to October 2022, 127 consecutive patients were included. Apixaban was chosen by 84%. Survey response rate was 74%. Patients who chose apixaban reported significantly reduced pain, bruising, increased confidence with administration, and less negative impact of the medication (p < 0.0001 for all). Adherence was unchanged (92%). The proportion of patients paying less than $125 (apixaban cost threshold) increased from 45% to 91%. There was no difference in bleeding and no VTE events.Introduction of apixaban for EP was associated with significant improvement in patient-reported quality measures and reduced financial toxicity with no effect on adherence or balancing measures. Apixaban is the preferred anticoagulant for EP at our centre.Copyright © 2024 Elsevier Inc. All rights reserved.