Original Research
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Introduction: Most thromboembolic events occur following bariatric surgery leading to significant morbidity and mortality. Extended venous thromboembolism (VTE) prophylaxis using direct oral anticoagulants in the post-operative setting following bariatric procedures is not recommended by current guidelines due limited data and malabsorption concerns.
Research Question or Hypothesis: To determine post-bariatric surgery 30-day VTE and bleeding event rates, as defined by International Society on Thrombosis and Haemostasis guidelines (ISTH) in those who received apixaban for VTE prophylaxis.
Study Design: Retrospective, single-center chart review
Methods: Apixaban 2.5 mg twice daily for two to four weeks post-operatively was utilized for extended VTE prophylaxis in patients undergoing sleeve gastrectomies or deemed high risk. Risk was calculated via the Cleveland Clinic Risk of Post-Discharge VTE after Bariatric Surgery calculator. A score above 0.4%, previous VTE history, hypercoagulable conditions or venous insufficiency were considered high risk. Eighty-three patients undergoing bariatric surgery discharged on apixaban were included. Demographics and surgical parameters were obtained from the electronic medical record. Any VTE or bleed events within 30 days post-bariatric surgery were described. Results were analyzed using descriptive statistics.
Results: The median risk score calculated pre-operatively was 0.16% [0.16 – 0.27] and 67 (80.7%) patients met criteria for VTE prophylaxis. Sixty two (74.7%) patients underwent a sleeve gastrectomy procedure. No VTE events were observed, however one patient experienced a splenic infarct that was considered related to surgery rather than apixaban. Four (4.8%) patients were noted to have clinically relevant non-major bleeding per ISTH definition and apixaban was discontinued for three patients.
Conclusion:
Apixaban use for extended VTE prophylaxis post-bariatric surgery resulted in no VTE events and minimal adverse effects. The patient population may have influenced results as most underwent sleeve gastrectomy procedures with low VTE risk scores. Additional data needed to further determine the efficacy and safety of routine use of apixaban for extended VTE prophylaxis in bariatric surgery.
Presenting Author
Taylor Rider Pharm.D., BCPSRochester General Hospital
Authors
Maura Wychowski Pharm.D., BCPS, CACP
Rochester General Hospital
Jessica Zagari Pharm.D.
Rochester General Hopsital