From Injections to Implementation: Standardizing Extended Oral Thromboprophylaxis After Bariatric Surgery

BackgroundVenous thromboembolism (VTE) is a major cause of morbidity and mortality after bariatric surgery, yet the optimal post-discharge prophylaxis agent, dose, and duration remain undefined. Direct oral anticoagulants are a potential alternative to low-molecular-weight heparin, but bariatric-specific data are limited. This study evaluates the successful implementation of a standardized 30-day oral thromboprophylaxis protocol with high completion rates and low observed rates of symptomatic VTE and major bleeding.MethodsA retrospective review of patients undergoing bariatric surgery (laparoscopic/robotic sleeve gastrectomy, gastric bypass, band-to-bypass and sleeve-to-bypass conversion) at a single institution from May 2021 to December 2024. Patients received perioperative unfractionated heparin followed by apixaban 2.5 mg twice daily for 30 days post-discharge if hemoglobin was stable on postoperative day one. Revisional surgery (anastomosis revision) and preexisting anticoagulant or antiplatelet therapy were exclusion criteria. The primary outcome was 30-day VTE incidence; the secondary outcome was bleeding requiring surgical or endovascular intervention.ResultsOf 764 patients, 669 completed the full 30-day apixaban course and were analyzed. No VTE events occurred (0%). One patient (0.15%) had a bleeding complication requiring reoperation for an intramural hematoma causing small bowel obstruction.ConclusionsA standardized institutional protocol utilizing apixaban 2.5 mg twice daily for 30 days following bariatric surgery can be implemented with high adherence and low complication rates. Further prospective, multi-institutional studies are warranted to validate these findings and refine patient selection.