From Injections to Implementation: Standardizing Extended Oral Thromboprophylaxis After Bariatric Surgery
Robert Monfort, Trisha Weber, Oluwaseun Olusanya, Madison Boyd, Reagan Kelly, Bolaji Olusanya, Kylie Tobey, Robert Parel, Danny VaughnBackground
Venous 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.
Methods
A 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.
Results
Of 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.
Conclusions
A 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.