Extended venous thromboembolism prophylaxis after bariatric surgery: the potential role of aspirin

Extended venous thromboembolism (VTE) prophylaxis after bariatric surgery remains an unresolved clinical issue. Current guidelines acknowledge the persistence of thrombotic risk beyond hospital discharge but do not define a standardized duration of pharmacological prophylaxis. In this perspective, a sequential strategy consisting of perioperative low-molecular-weight heparin followed by post-discharge aspirin is presented as a biologically plausible and pragmatically testable strategy for extended VTE prophylaxis in selected higher-risk bariatric patients. Persistent postoperative platelet hyperreactivity may contribute to sustained thrombotic risk after hospital discharge, providing a mechanistic basis for antiplatelet therapy during the extended prophylaxis phase. Although evidence supporting aspirin in this setting remains indirect, its oral administration, potential effects on platelet-mediated thrombosis, and favorable adherence profile support its evaluation as a hypothesis-generating strategy in this population.