Key result
Post-bariatric surgery apixaban prophylaxis yields a ~5% adverse event rate with zero VTE or major bleeds.
Why the study?
The optimal strategy for extended venous thromboembolism chemoprophylaxis after bariatric surgery remains uncertain, and real-world safety data for apixaban in this population are limited.
Does apixaban safely prevent postoperative venous thromboembolism in adult patients undergoing bariatric surgery?
Cohort (n=540)
No
Does apixaban safely prevent postoperative venous thromboembolism in adult patients undergoing bariatric surgery?
A 30-day course of apixaban provides a safe and effective extended VTE prophylaxis strategy after bariatric surgery, with zero VTE or major bleeding events, though women require counseling on non-major bleeding risks.
Answers are grounded in this paper and cite their sources.
Apixaban merits prospective evaluation for post-bariatric VTE prophylaxis; observational data leave open questions of efficacy and generalizability.
Background Venous thromboembolism (VTE) is a major postoperative concern after bariatric surgery, and the optimal strategy for extended chemoprophylaxis remains uncertain. Direct oral anticoagulants such as apixaban offer convenience, yet real-world safety data in bariatric patients are limited. This study evaluated the safety of apixaban for post-discharge VTE prophylaxis in a high-volume tertiary centre. Methods We performed a retrospective cohort study at the Bariatric Centre of Kafrelsheikh University Hospitals, Egypt. Adults undergoing primary or revisional bariatric surgery between January 1, 2022 and May 30, 2025 who received apixaban prophylaxis were included (n=540). Apixaban 2.5 mg twice daily was initiated about 72 hours postoperatively and continued for 30 days. Outcomes at 30 and 90 days included any adverse event (AE), VTE, major bleeding, clinically relevant non-major bleeding (CRNMB), skin reactions, readmission, return to theatre, transfusion, and mortality. Results AEs occurred in 28 patients (5.2%). CRNMB primarily vaginal bleeding was most common (3.0%), followed by skin rash (2.2%). No VTE or major bleeding events were detected; the upper 95% confidence bound for these zero-event outcomes was 5.6 per 1000. All AEs occurred in female patients, showing a significant association with sex (P=0.0084). Conclusions A 30-day postoperative course of apixaban showed a favourable short-term safety profile in this 540-patient cohort, with no observed VTE or major bleeding. Apixaban appears to be a practical option for extended prophylaxis, with attention to counselling women regarding non-major bleeding risk.
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Mohamed Abosheisha (2026) conducted a cohort in Venous thromboembolism (VTE) prophylaxis after bariatric surgery (n=540). Apixaban was evaluated on Any adverse event (AE). Apixaban for post-discharge VTE prophylaxis after bariatric surgery resulted in a 5.2% rate of adverse events, with no observed venous thromboembolism or major bleeding events.
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