Impact of Prophylactic Apixaban for 14 Days After Sleeve Gastrectomy on Thromboembolic Events and Its Side Effects.

BACKGROUND

Venous thromboembolism (VTE) is a significant complication following bariatric surgery, with most events occurring after discharge. While inpatient VTE chemoprophylaxis is well-established, its extension post-discharge remains controversial. Apixaban, an oral direct factor Xa inhibitor, is a potential alternative for this purpose, offering convenience and a favorable safety profile compared to enoxaparin. This study evaluates the efficacy and safety of a 14-day apixaban regimen in preventing VTE after sleeve gastrectomy (SG).

METHODS

This retrospective review analyzed 2737 SG patients who received apixaban 2.5 mg twice daily for 14 days post-discharge between January 2018 and September 2024. Demographics, baseline characteristics, and postoperative complications were collected, focusing on VTE and bleeding events. Patients with contraindications to apixaban, therapeutic anticoagulation, or revisional procedures were excluded.

RESULTS

VTE occurred in 0.1% (3/2737) of patients, all presenting as portomesenteric vein thrombosis. The mean time to diagnosis was 18 days. Bleeding complications were observed in 0.4% (11/2,737) of patients, with abdominal bleeding being the most common source. Most bleeding events were managed conservatively, with only two cases requiring invasive interventions. No deaths or cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) were reported.

CONCLUSIONS

A 14-day apixaban prophylactic regimen after SG demonstrated low rates of VTE and bleeding complications, comparable to longer regimens and enoxaparin in the literature. Apixaban's fixed dosing, oral administration, and safety profile make it a strong candidate for extended VTE prophylaxis in SG patients. Prospective studies are warranted to validate these findings and inform guideline revisions.