Safety of Apixaban for Postoperative Venous Thromboembolism Prophylaxis After Bariatric Surgery: A Single-Centre Retrospective Cohort Study.

BACKGROUND

Venous thromboembolism (VTE) is still one of the major life-threatening complications that can occur after bariatric surgery. However, the question of the best post-discharge chemoprophylaxis has not yet been ‍‌‍‍‌‍‌‍‍‌clarified. Direct oral anticoagulants such as apixaban offer practical advantages, but real-world safety data in bariatric populations are still evolving. This study aimed to evaluate the safety of apixaban for postoperative VTE prophylaxis after bariatric surgery in a high-volume tertiary centre.

METHODS

We conducted a single-centre retrospective cohort study at the Bariatric Centre of Kafrelsheikh University Hospitals, Egypt. Adult patients who underwent primary or revisional bariatric surgery between January 1, 2022, and May 30, 2025, and received apixaban for postoperative prophylaxis were included (n = 540). Apixaban was prescribed as 2.5 mg twice daily, initiated at approximately 72 h postoperatively, and continued for 30 days. Outcomes were assessed at 30 and 90 days. The primary outcome was any adverse event (AE). Secondary outcomes included VTE, major bleeding, clinically relevant non-major bleeding (CRNMB), skin reactions, readmission, return to theatre, transfusion, and mortality.

RESULTS

Adverse events occurred in 28/540 patients (5.2%). The most frequent event was CRNMB in 16 patients (3.0%), clinically presenting as vaginal bleeding, followed by skin rash in 12 patients (2.2%). No symptomatic VTE or major bleeding events were observed at 30 or 90 days; however, using the rule of three, the estimated upper 95% confidence bound was 5.6 per 1000, indicating that a low event risk cannot be excluded. All patients with adverse events were women (P = 0.0084).

CONCLUSIONS

In this 540-patient retrospective cohort, a 30-day course of apixaban after bariatric surgery demonstrated a favorable short-term safety profile with no observed VTE or major bleeding. These findings support apixaban as a practical option for extended post-discharge VTE prophylaxis in routine bariatric practice, with targeted counselling for sex-specific bleeding risk.