Evidence map›Paper›PMID 42260174›Full record

ArticleSurgical endoscopy2026

Post-discharge VTE prophylaxis after bariatric surgery: balancing bleeding risk and thrombosis prevention in 275,843 patients.

Andrew P Gillikin, Emily P Rabinovich, Juan S Barajas-Gamboa, Valentin Mocanu, Jerry T Dang, Cullen Carter, Peter Hallowell, Bruce Schirmer, Thomas H Shin

Abstract read
In one paragraph

Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Andrew P GillikinDepartment of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Emily P RabinovichDepartment of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Juan S Barajas-GamboaDigestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Valentin MocanuDigestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Jerry T DangDigestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Cullen CarterDepartment of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Peter HallowellDepartment of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Bruce SchirmerDepartment of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Thomas H ShinDepartment of Surgery, University of Virginia School of Medicine, 1300 Jefferson Park Ave, 4th Floor, Charlottesville, VA, 22903, USA. thomas.shin@uvahealth.org.ORCID http://orcid.org/0000-0003-2076-270X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPost-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.

methodsA 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.

resultsAmong 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.

conclusionsPost-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.

Indexed as

AnticoagulantsBariatric SurgeryPostoperative ComplicationsPostoperative HemorrhageVenous ThromboembolismAdultEnoxaparinFemaleHumansIncidenceMaleMiddle AgedPatient DischargePropensity ScoreRetrospective StudiesAnticoagulantsEnoxaparinAnticoagulationBariatric surgeryExtended thromboprophylaxisPost-discharge prophylaxisVenous thromboembolism (VTE)

Identifiers

PMID42260174
PMCPMC13369671

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.