Oral rivaroxaban for postoperative prophylaxis of venous thromboembolism after sleeve gastrectomy in patients with morbid obesity, is it safe: A prospective randomized clinical trial

Background: Deep vein thrombosis and pulmonary embolism are still one of the most crucial problems after weightreducing surgeries in patients suffering from obesity. Many techniques were documented and routinely applied to preventvenous thromboembolism (VTE), particularly in those who are at high risk as morbid obese patients (BMI >40 kg/m2),geriatric patients, and those who had previous history of VTE and open or revisional surgery.Patients and Methods: We conducted this randomized prospective clinical trial during the period from January 2021 toJanuary 2023 on 500 obese patients who underwent sleeve gastrectomy for weight reduction divided into two groups: In the250 patients of group A we used postoperative low-molecular-weight heparins (LMWH) 40 mg once daily subcutaneousinjection for VTE prophylaxis, while group B (250 patients) were given oral anticoagulants (rivaroxaban) on the otherhand.Results: This study aimed to compare the results of using both drugs as regards complications including both VTE andbleeding. Regarding bleeding, it also can present with a wide range of manifestations ranging from mild symptoms likeport site hematoma, perigastric hematoma, or hematemesis, and melena.Regarding the age of patients in the studied groups there was no statistically significant difference between both groups.The incidence of minor, moderate to major, and life-threatening bleeding was nearly the same between both groups withno statistically significant difference. Throughout the study, only one case of porto-mesenteric thrombosis in the LMWHgroup. No clinically suspected Lower Limb deep vein thrombosis throughout the study with no need to do lower limbvenous duplex.Conclusion: The safety and efficacy of Rivaroxaban as one of the most commonly used new Oral anticoagulants resemblesthat of the LMWH as a prophylaxis of VTE following weight-reducing sleeve gastrectomy surgery and could be a goodoral alternative for LMWH.