Extended Post Discharge Prophylaxis for Venous Thromboembolism Prevention After Bariatric Surgery

Area of Science:

• Bariatric Surgery
• Vascular Surgery
• Pharmacology

Background:

• Post-bariatric surgery venous thromboembolism (VTE) remains a concern, with most events occurring post-discharge.
• Inpatient prophylaxis is insufficient for preventing fatal pulmonary embolism.
• Extended oral chemoprophylaxis is being explored to mitigate post-discharge VTE risk.

Purpose of the Study:

• To evaluate the efficacy and safety of routine 30-day post-discharge extended prophylaxis with apixaban after bariatric surgery.
• To compare post-discharge VTE, bleeding, readmission, and reoperation rates between patients receiving apixaban and those who did not.

Main Methods:

• A retrospective study of 2396 bariatric operations (sleeve gastrectomy, Roux-en-Y gastric bypass, duodenal switch) between January 2014 and July 2022.
• Apixaban (2.5 mg BID for 30 days) was administered as routine extended prophylaxis starting May 2017.
• Exclusion criteria included concerns for postoperative bleeding or preoperative anticoagulant/antiplatelet use (excluding aspirin).

Main Results:

• No post-discharge VTEs occurred in the apixaban group (n=1443) versus five VTEs (0.5%) in the control group (n=953) (p=0.02).
• A slightly higher incidence of post-discharge bleeding events was observed in the apixaban group (0.5% vs. 0.3%, p=0.75), primarily requiring monitoring without intervention or transfusion.
• One patient in the apixaban group required EGD for bleeding, and another needed a blood transfusion; no reoperations for bleeding occurred.

Conclusions:

• Routine 30-day post-discharge apixaban prophylaxis after bariatric surgery effectively prevented VTE events.
• The observed increase in bleeding events was minor and self-limiting.
• This study supports the use of extended oral chemoprophylaxis to improve outcomes in bariatric surgery patients.