Post-discharge VTE prophylaxis after bariatric surgery: balancing bleeding risk and thrombosis prevention in 275,843 patients.
Source: PubMed, NCBI / U.S. National Library of Medicine
Post-discharge venous thromboembolism (VTE) chemoprophylaxis after metabolic and bariatric surgery is variably implemented in clinical practice, although the optimal pharmacologic agent and dosing regimen remain unclear. This study characterized national practice patterns in VTE chemoprophylaxis and evaluated the associations of commonly prescribed post-discharge prophylactic regimens with VTE and bleeding outcomes. A retrospective analysis of a national database identified adult patients undergoing primary sleeve gastrectomy (n = 184,587) or Roux-en-Y gastric bypass (n = 91,256) between 2018 and 2025. The primary outcomes were VTE and bleeding events through 90 postoperative days (POD). Multivariable logistic regression and propensity score matching were used to evaluate the associations of common chemoprophylaxis regimens with VTE and bleeding. Among 275,843 patients undergoing metabolic and bariatric surgery, 63,744 (23.1%) received post-discharge chemoprophylaxis. Overall post-discharge VTE incidence was 0.45% at POD30 and 0.61% at POD90. Enoxaparin 40 mg once daily was the most frequently prescribed regimen (35.8%; n = 22,799). On multivariable analysis, apixaban 2.5 mg twice daily (OR 0.62, 95% CI 0.41-0.90), rivaroxaban 10 mg once daily (OR 0.55, 95% CI 0.26-0.99), and enoxaparin 40 mg twice daily (OR 0.72, 95% CI 0.58-0.88) were independently associated with lower odds of VTE through POD90 without increased
Abstract
Post-discharge venous thromboembolism (VTE) chemoprophylaxis after metabolic and bariatric surgery is variably implemented in clinical practice, although the optimal pharmacologic agent and dosing regimen remain unclear. This study characterized national practice patterns in VTE chemoprophylaxis and evaluated the associations of commonly prescribed post-discharge prophylactic regimens with VTE and bleeding outcomes. A retrospective analysis of a national database identified adult patients undergoing primary sleeve gastrectomy (n = 184,587) or Roux-en-Y gastric bypass (n = 91,256) between 2018 and 2025. The primary outcomes were VTE and bleeding events through 90 postoperative days (POD). Multivariable logistic regression and propensity score matching were used to evaluate the associations of common chemoprophylaxis regimens with VTE and bleeding. Among 275,843 patients undergoing metabolic and bariatric surgery, 63,744 (23.1%) received post-discharge chemoprophylaxis. Overall post-discharge VTE incidence was 0.45% at POD30 and 0.61% at POD90. Enoxaparin 40 mg once daily was the most frequently prescribed regimen (35.8%; n = 22,799). On multivariable analysis, apixaban 2.5 mg twice daily (OR 0.62, 95% CI 0.41-0.90), rivaroxaban 10 mg once daily (OR 0.55, 95% CI 0.26-0.99), and enoxaparin 40 mg twice daily (OR 0.72, 95% CI 0.58-0.88) were independently associated with lower odds of VTE through POD90 without increased odds of bleeding compared with no prophylaxis. In propensity score-matched analyses, 90-day VTE incidence was lower for apixaban 2.5 mg twice daily (0.41% vs. 0.64%; p = 0.050; q = 0.050) and enoxaparin 40 mg twice daily (0.53% vs. 0.75%; p = 0.003) compared with matched controls. Post-discharge VTE chemoprophylaxis after metabolic and bariatric surgery varies substantially, with meaningful differences in safety and effectiveness across regimens. In propensity score-matched analyses, apixaban 2.5 mg twice daily and enoxaparin 40 mg twice daily were each associated with lower 90-day VTE incidence compared with matched controls, without significant increase in bleeding. Prospective randomized studies are needed to define optimal patient selection, regimen selection, and therapy duration.