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Risk-Stratified Thromboembolic and Bleeding Outcomes Following Sleeve Gastrectomy Under Uniform Extended Enoxaparin
Mehmet Emin Gönüllü1, Mehmet Fuat Çetin2, Fatih Gürsoy2
1Faculty of Medicine, Department of General Surgery, Bilecik Seyh Edebali University, Bilecik, Turkey. dr.m.emin.gonullu@gmail.com.
Background And Objective:
Venous thromboembolism (VTE) remains a relevant complication after bariatric surgery despite routine extended thromboprophylaxis. This study evaluated 90-day thromboembolic and bleeding outcomes following laparoscopic sleeve gastrectomy under a standardized enoxaparin protocol and examined their association with baseline risk assessed by the Caprini Risk Assessment Model.
Methods:
This retrospective cohort study included 348 patients who underwent primary laparoscopic sleeve gastrectomy between 2015 and 2025. All patients received extended enoxaparin prophylaxis for 21 days. Patients were stratified into low (≤ 4), moderate (5-6), and high (≥ 7) risk groups according to Caprini score. The primary outcome was 90-day VTE. Secondary outcomes included bleeding events and hospital readmission. Comparative analyses, univariable logistic regression, and receiver operating characteristic (ROC) analyses were performed.
Results:
The incidence of VTE increased progressively across risk categories (0.9%, 3.2%, and 8.9% in the low-, moderate-, and high-risk groups, respectively; p = 0.006). Clinically relevant minor bleeding also increased across groups (4.9%, 8.3%, and 12.2%, respectively; p = 0.047), whereas major bleeding remained infrequent (2.0%, 2.6%, and 4.4%; p = 0.284). In univariable analysis, the Caprini score was significantly associated with 90-day VTE (OR: 1.48, 95% CI: 1.26-1.74; p < 0.001). ROC analysis demonstrated acceptable discriminative performance (AUC: 0.78, 95% CI: 0.70-0.86), with an optimal cut-off value of ≥ 7 (sensitivity: 78.6%, specificity: 71.2%, negative predictive value: 96.8%).
Conclusion:
Within a homogeneous cohort undergoing laparoscopic sleeve gastrectomy and managed with standardized extended enoxaparin prophylaxis, thromboembolic and bleeding outcomes varied according to baseline VTE risk. Thromboembolic events increased progressively across Caprini risk categories despite uniform prophylaxis, whereas major bleeding remained uncommon. These findings support further evaluation of risk-adapted thromboprophylaxis strategies. Given the retrospective design and limited number of thromboembolic events, the results should be considered hypothesis-generating and require confirmation in prospective studies.
