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27.02.2024 | Original Contributions

Extended Post Discharge Prophylaxis for Venous Thromboembolism Prevention After Bariatric Surgery

verfasst von: Francisco A. Guzman-Pruneda, Ambar Garcia, Robert W. Crum, Theresa Chen, Abraham Krikhely, Marc Bessler

Erschienen in: Obesity Surgery | Ausgabe 4/2024

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Abstract

Purpose

The utility of routine post-discharge VTE prophylaxis after bariatric surgery remains a matter of debate. While inpatient chemical prophylaxis decreases the risk of fatal pulmonary embolism, most thromboembolic events occur after discharge and carry high morbidity and mortality. To address this risk, apixaban was introduced as extended prophylaxis for 30 days after surgery.

Materials and Methods

The study ranges between 1/2014 and 7/2022. Apixaban was incorporated as routine extended prophylaxis protocol in 05/2017 and is dosed at 2.5 mg BID for 30 days. There were two study groups: those who received apixaban on discharge (n = 1443; 60%) and those who did not (n = 953; 40%). Patients with concern for postoperative bleeding (hypotension, unexplained tachycardia with hematocrit drop > 6%, hematocrit drop > 9%), or on preoperative anticoagulant/antiplatelet therapy (except aspirin), were not discharged on apixaban. Post-discharge VTE, readmission, transfusion, and reoperation rates were compared between groups.

Results

There were 2396 consecutive primary bariatric operations: sleeve gastrectomy (1949; 81%), Roux-en-Y gastric bypass (419; 18%), and duodenal switch (28; 1%). There were no post-discharge VTEs in patients treated with apixaban vs. five (0.5%) VTEs in patients who did not receive treatment; p = 0.02. There was a higher incidence in post-discharge bleeding events in the apixaban group (0.5 vs 0.3%; p = 0.75), mostly requiring readmission for monitoring without intervention or transfusion. In the apixaban group, one patient underwent EGD for bleeding while another required blood transfusion; there were no reoperations for bleeding.

Conclusion

There were no post-discharge VTEs in patients who received apixaban. Treatment was associated with a higher risk of self-resolving bleeding events. This study adds to the increasing body of evidence supporting the benefit of routine, extended oral chemoprophylaxis after bariatric surgery.

Graphical Abstract

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Titel: Extended Post Discharge Prophylaxis for Venous Thromboembolism Prevention After Bariatric Surgery
verfasst von: Francisco A. Guzman-Pruneda
Ambar Garcia
Robert W. Crum
Theresa Chen
Abraham Krikhely
Marc Bessler
Publikationsdatum: 27.02.2024
Verlag: Springer US
Erschienen in: Obesity Surgery / Ausgabe 4/2024
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07100-z

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Extended Post Discharge Prophylaxis for Venous Thromboembolism Prevention After Bariatric Surgery