Extended venous thromboembolism prophylaxis after bariatric surgery does not increase postoperative bleeding...

At our institution, an extended venous thromboembolism prophylaxis protocol was initiated in which all patients undergoing bariatric surgery received a minimum of 2 weeks of enoxaparin prophylaxis postoperatively. The objective of this study was to evaluate the safety of this extended venous thromboembolism prophylaxis protocol.

Patients who underwent primary bariatric surgery between 2020 and 2024 were identified using our institution's bariatric surgery database. Venous thromboembolism rates, bleeding complications, and emergency department visits within 30 days of surgery before and after protocol implementation were compared. For outcomes that had statistically significant differences before and after protocol implementation, multivariable logistic regression analysis was used to identify associated factors.

We included 327 patients before and 573 patients after protocol implementation. There were no differences in rates of venous thromboembolism (0.9% vs 0.2%, P = .14), bleeding complications (1.8% vs 1.9%, P = .93), and emergency department visits (5.2% vs 7.5%, P = .18) before and after protocol implementation. When stratified by surgery type, there were no differences in rates of venous thromboembolism or bleeding complications. Patients who underwent gastric bypass had higher rates of emergency department visits after protocol implementation (11.5% vs 4.3%, P = .02). On multivariable analysis, implementation of venous thromboembolism prophylaxis protocol was not associated with increased odds of having an emergency department visit.

Use of extended venous thromboembolism prophylaxis for all patients undergoing bariatric surgery is safe, with no differences in bleeding complications or emergency department visits. Future studies will aim to assess the impact that extended prophylaxis has on venous thromboembolism rates.