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30-Day Post-Discharge Prophylaxis with Rivaroxaban Prevents Porto-mesenteric Venous Thrombosis Following Laparoscopic Sleeve Gastrectomy

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Abstract

Introduction

Porto-mesenteric venous thrombosis (PMVT) is a significant complication that occurs more frequently after laparoscopic sleeve gastrectomy (SG) than other bariatric procedures and presents later than other venous thromboembolic (VTE) events often 2 weeks after the operation. The common current practice in bariatric surgery of perioperative chemoprophylaxis until discharge may not adequately prevent PMVT. Therefore, a 30-day post-discharge chemoprophylaxis (PDC) might reduce the incidence of PMVT. The objective of this study is to determine whether 30-day PDC with rivaroxaban 10 mg daily following SG can reduce the incidence of PMVT.

Methods

In a retrospective cohort study, 292 consecutive patients undergoing SG by a single surgeon were either prescribed rivaroxaban 10 mg daily for 30 days upon discharge (group A) or did not receive any PDC (group B). Primary outcome was PMVT and secondary outcome was bleeding. Patients on chronic anticoagulation therapy were excluded from the study.

Results

PMVT events differences were significant between the groups while bleeding events were not. Group A had zero PMVT events, while group B had four (p = .045). There were 4 bleeding events in group A and 7 bleeding events on group B (p = .341).

Conclusion

A 30-day PDC regimen of rivaroxaban 10 mg daily is both safe and effective. This study demonstrated zero PMVT events without an increased risk of bleeding using this regimen.

Graphical Abstract

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References

  1. Dang JT, Switzer N, Delisle M, et al. Predicting venous thromboembolism following laparoscopic bariatric surgery: development of the BariClot tool using the MBSAQIP database. Surg Endosc. 2019;33:821–31.

    Article  PubMed  Google Scholar 

  2. Clark LN, Helm MC, Gould JC. Practice patterns regarding post-discharge chemoprophylaxis for venous thromboembolism following bariatric surgery in the United States. Surg Obes Rel Dis. 2019;15:703–7.

    Article  Google Scholar 

  3. Abdelsalam AM, ElAnsary AMSE, Salman MA, et al. Adding a preoperative dose of LMWH may decrease VTE following bariatric surgery. World J Surg. 2021;45:126–31.

    Article  PubMed  Google Scholar 

  4. Caruso F, Cesana G, Lomaglio L, et al. Is portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy related to short-course prophylaxis of thromboembolism? A moncentric retrospective analysis about an infrequent but not rare complications and review of the literature. J Laparoendosc Adv Surg Tech A. 2017;27:987–96.

    Article  PubMed  Google Scholar 

  5. Fennern EB, Farjah F, Chen JY, et al. Use of post-discharge heparin prophylaxis and the risk of venous thromboembolism and bleeding following bariatric surgery. Surg Endosc. 2021;35:5531–7.

    Article  PubMed  Google Scholar 

  6. Finks JF, English WE, Carlin AM, et al. Predicting risk for venous thromboembolism with bariatric surgery. Results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255:1100–4.

    Article  PubMed  Google Scholar 

  7. Jamal MH, Corcelles R, Shimizu H, et al. Thromboembolic events in bariatric surgery: a large multi-institutional referral center experience. Surg Endosc. 2015;29:376–80.

    Article  PubMed  Google Scholar 

  8. Nielsen AW, Helm MC, Kindel T, et al. Perioperative bleeding and blood transfusion are major risk factors for venous thromboembolism following bariatric surgery. Surg Endosc. 2018;32:2488–95.

    Article  PubMed  Google Scholar 

  9. Raftopoulos I, Martindale C, Cronin A, et al. The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg Endosc. 2008;22(11):2384–91.

    Article  PubMed  Google Scholar 

  10. Belnap L, Rodgers GM, Cottam D, et al. Portal vein thrombosis after laparoscopic sleeve gastrectomy: presentation and management. Surg Obes Rel Dis. 2016;12:1787–94.

    Article  Google Scholar 

  11. Gambhir S, Inaba C, Alizadeh RF, et al. Venous thromboembolism risk for the contemporary bariatric surgeon. Surg Endosc. 2020;34:3521–6.

    Article  PubMed  Google Scholar 

  12. Gordoja D, Hainarosie D, Zaharancu A, et al. Portal vein thrombosis a rare but life-threatening complication after laparoscopic sleeve gastrectomy: a 5 years study in a bariatric center of excellence. Chirurgia (Bucur). 2019;114:711–24.

    Article  Google Scholar 

  13. Salinas J, Barros D, Salgado N, et al. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Surg Endosc. 2014;28:1083–9.

    Article  PubMed  Google Scholar 

  14. Shoar S, Saber AA, Rubenstein R, et al. Portomesenteric and splenic vein thrombosis (PMSVT) after bariatric surgery: a systemic review of 110 patients. Surg Obes Rel Dis. 2018;14:47–59.

    Article  Google Scholar 

  15. Tan SBM, Greenslade J, Martin D, et al. Portomesenteric vein thrombosis in sleeve gastrectomy: a 10-year review. Surg Obes Rel Dis. 2018;14:271–6.

    Article  Google Scholar 

  16. El Lakis MA, Pozzi A, Chamieh J, et al. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass: a 36-case series. Surg Endosc. 2017;31:1005–11.

    Article  PubMed  Google Scholar 

  17. Shaheen O, Siejka J, Thatigotla B, et al. A systematic review of portosystemic vein thrombosis after sleeve gastrectomy. Surg Obes Rel Dis. 2017;13:1422–33.

    Article  Google Scholar 

  18. Raskob GE, Hirsh J. Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery. Chest. 2003;124(6 Suppl):379S-S385.

    Article  PubMed  Google Scholar 

  19. Najjar PA, Madenci AL, Zogg CK, et al. Implementation of post-discharge venous thromboembolism prophylaxis program for abdominal and pelvic surgery patients. J Am Coll Surg. 2016;223:804–13.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vedovati MC, Becattini C, Rondelli F, et al. A randomized study of 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer. Ann Surg. 2014;259:665–9.

    Article  PubMed  Google Scholar 

  21. Spyropoulos AC, Ageno W, Albers GW, et al. Post-discharge prophylaxis with rivaroxaban reduces fatal and mahor thromboembolic events in medically ill patients. J Amer Coll Cardiol. 2020;75:3140–7.

    Article  CAS  Google Scholar 

  22. The American Society for Metabolic and Bariatric Surgery updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Rel Dis. 2013;9:493–7.

  23. Theraux J, Lesuffleur T, Czernichow S, et al. To what extent does posthospital discharge chemoprophylaxis prevent venous thromboembolism after bariatric surgery? Ann Surg. 2018;267:727–33.

    Article  Google Scholar 

  24. Saldado N, Becerra P, Briceno E, et al. Splenic rupture as a complication of sleeve gastrectomy. Sug Obes Rel Dis. 2012;8:e72–4.

    Article  Google Scholar 

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Authors and Affiliations

  1. Saint Agnes Care Metabolic and Bariatric Surgery, Saint Agnes Medical Center, 1510 East Herndon Ave., Ste 210, Fresno, CA, 93720, USA

    Daniel E. Swartz, Lisa Hood & Devin R. Swartz

  2. California Cancer Associates for Research & Excellence, Fresno, CA, USA

    Sachin Gupta

Authors
  1. Daniel E. Swartz
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  2. Lisa Hood
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  4. Sachin Gupta
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Correspondence to Daniel E. Swartz.

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Conflict of Interest

Dr. Swartz and Ms. Hood receive financial support for attending symposia by their employer. Dr. Swartz is a consultant for Intuitive Surgical Inc.

All other authors declare no competing interests.

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Key Points

• Portovenous mesenteric venous thrombosis (PMVT) is a relatively rare complication of sleeve gastrectomy (1–3%) but may be associated with significant morbidity and mortality.

• Current venous thromboembolic (VTE) chemoprophylactic regimens for bariatric surgery vary widely, and extended post-discharge prophylaxis is not routinely used.

• PMVT occurs at a median time of 14 days post-sleeve gastrectomy and may not be adequately prophylaxed by a short in-hospital course of anticoagulation.

• This study found that patients receiving a 30-day postoperative regimen of rivaroxaban added to perioperative anticoagulation did not develop PMVT, while a similar cohort of patients receiving perioperative anticoagulation only had a 2.7% incidence (p=0.043).

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Swartz, D.E., Hood, L., Swartz, D.R. et al. 30-Day Post-Discharge Prophylaxis with Rivaroxaban Prevents Porto-mesenteric Venous Thrombosis Following Laparoscopic Sleeve Gastrectomy. OBES SURG 33, 1026–1031 (2023). https://doi.org/10.1007/s11695-023-06471-z

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