Comparison between low molecular weight heparin and apixaban (direct oral anticoagulant) in the prophylaxis against venous thromboembolism after laparoscopic sleeve gastrectomy

Obes Surg. 2025 Mar;35(3):934-940. doi: 10.1007/s11695-025-07721-y. Epub 2025 Feb 8.

Abstract

Background: Like any major operation, sleeve gastrectomy (SG) has its reported postoperative complications. Among them are venous thromboembolic complications (VTE) that may predispose to mortality. Despite the proven efficacy of the traditional anticoagulants, such as low molecular weight heparins (LMWHs) for VTE management, they have their limitations. Direct oral anticoagulants (DOACs) have been currently adopted for the management of VTE. We conducted this study to evaluate the efficacy and safety of apixaban against VTE after laparoscopic sleeve gastrectomy in comparison with LMWH.

Methods: This was a randomized controlled trial that included 100 adult patients who underwent SG and received LMWH (Group A) or apixaban (Group B) for VTE prophylaxis. We recorded and analyzed the postoperative events up to the 30th day after surgery.

Results: This study included Group A (n = 50) and Group B (n = 50). No VTE occurred in either group (0%). Postoperative bleeding was encountered in one patient of each group (2%). The follow-up venous Doppler study was unremarkable in the two groups.

Conclusion: Apixaban was shown to be comparable to LMWH for the prevention of VTE after LSG with similar efficacy and safety making it a promising alternative to LMWH in patients undergoing bariatric surgery.

Keywords: Apixaban; Bariatric surgery; Direct oral anticoagulants; Venous thromboembolic complications.

Publication types

  • Randomized Controlled Trial
  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adult
  • Anticoagulants / therapeutic use
  • Factor Xa Inhibitors* / therapeutic use
  • Female
  • Gastrectomy* / adverse effects
  • Gastrectomy* / methods
  • Heparin, Low-Molecular-Weight* / therapeutic use
  • Humans
  • Laparoscopy / adverse effects
  • Male
  • Middle Aged
  • Obesity, Morbid* / surgery
  • Postoperative Complications* / prevention & control
  • Pyrazoles* / administration & dosage
  • Pyrazoles* / therapeutic use
  • Pyridones* / administration & dosage
  • Pyridones* / therapeutic use
  • Treatment Outcome
  • Venous Thromboembolism* / etiology
  • Venous Thromboembolism* / prevention & control

Substances

  • Anticoagulants
  • apixaban
  • Factor Xa Inhibitors
  • Heparin, Low-Molecular-Weight
  • Pyrazoles
  • Pyridones