Prolonged thromboprophylaxis with rivaroxaban after bariatric interventions: A single-centre experience

Introduction: Venous thromboembolism (VTE) is common after bariatric surgery, and extended prophylaxis is generally recommended. Low-molecular-weight heparin (LMWH) is the most common agent, but it requires patients to be trained to self-inject and is expensive. Rivaroxaban is an oral daily formulation approved for VTE prophylaxis after orthopaedic surgery. The efficacy and safety of rivaroxaban have been confirmed in major gastrointestinal resections by several observational studies. We report a single-centre experience of using rivaroxaban as an agent for VTE prophylaxis in bariatric surgery. Materials and methods: We performed a prospective cohort study assessing the safety and efficacy of rivaroxaban as a medication for VTE prophylaxis in patients undergoing bariatric surgery in a single centre in Kyiv, Ukraine. The patients undergoing a major bariatric procedure received perioperative VTE prophylaxis with subcutaneous LMWH and were then switched to rivaroxaban for a total of 30 days starting on the 4^th postoperative day. Thromboprophylaxis was performed in accordance with the VTE risks derived from the Caprini score. On the 3^rd, 30^th and 60^th days after the operation, the patients underwent ultrasound examination of the portal vein, as well as the veins of the lower extremities. Telephone interviews were conducted 30 and 60 days after the surgery to evaluate the presence of complaints which may indicate VTE and to assess the patients’ compliance with the regimen and satisfaction. The outcomes of the study were incidence of VTE and adverse events related to rivaroxaban administration. Results: A total of 110 patients were included in the study from July 2019 to May 2021. The average age of the patients was 43.6 years, and the average preoperative BMI was 55 (35 to 75). Of these patients, 107 (97.3%) underwent laparoscopic intervention, while 3 (2.7%) underwent laparotomy. Eighty-four patients underwent sleeve gastrectomy, and 26 underwent other procedures, including bypass surgery. The average calculated risk of thromboembolic event was 5–6% based on the Caprini score. All patients were treated with extended prophylaxis with rivaroxaban. The average follow-up period for patients was 6 months. There was no clinical or radiological evidence of thromboembolic complications in the study cohort. The overall complication rate was 7.2%; only 1 patient (0.9%) developed subcutaneous haematoma associated with rivaroxaban which did not require intervention. Conclusion: Extended postoperative prophylaxis with rivaroxaban is safe and effective in preventing thromboembolic complications in patients undergoing bariatric surgery. It is preferred by patients and further studies should be considered to evaluate its use in bariatric surgery.