Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis

Abstract

Introduction Portal and mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic sleeve gastrectomy. There are no consistent studies that prove the safety and effectiveness of oral anticoagulant thromboprophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy. The objective was to evaluate the effect of rivaroxaban on the frequency of portal and mesenteric venous thrombosis and its safety profile after laparoscopic sleeve gastrectomy. Materials and methods This retrospective analysis of prospectively collected data includes all laparoscopic sleeve gastrectomies performed by a single surgeon at Pontificia Universidad Católica de Chile Hospital between January 2009 and June 2019. All patients received low molecular weight heparin thromboprophylaxis during the whole hospital stay. Between July 2012 and June 2019, patients received additional post-discharge thromboprophylaxis with rivaroxaban. Patient demographics, impaired renal, post-surgical portal and mesenteric venous thrombosis, and bleeding episodes were registered. Results A total of 516 patients were identified; 95 patients were excluded. Results for 421 patients were analysed: 198 received only intrahospital thromboprophylaxis (group 1) and 223 received additional post-discharge thromboprophylaxis with rivaroxaban (group 2). There was no statistically significant difference between the two groups concerning age, sex and body mass index. In group 1, four cases of portal and mesenteric venous thrombosis were registered and no cases were reported in group 2 (p < 0.05). All cases occurred before 30 days after surgery. No bleeding episodes and no adverse reactions were detected in group 2. Conclusions Thromboprophylaxis during the whole hospital stay (two to three days), followed by rivaroxaban 10mg once daily for 10 days after discharge (completing in total 13–14 days of prophylaxis), could reduce cases of post-surgical portal and mesenteric venous thrombosis without an increase in bleeding complications.

Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery

“…Although associated risk factors such as procedure type and a history of hypercoagulability have been described, specific independent predictors for PVT are not well defined (5,6) . In addition, prior studies have demonstrated that the majority of PVTs occur within the first postoperative month, which supports the use of extended prophylaxis (7,8) . However, appropriate patient selection, effectiveness, and exact duration of any chemoprophylaxis to prevent PVT remains unclear.…”

“…This has therapeutic implications for the duration of extended chemoprophylaxis required to reduce the risk of PVT following bariatric surgery. Extended chemoprophylaxis to prevent PVT has been advocated by some, but patient selection, effectiveness, and duration of therapy has been unclear (7,8) . Based on our findings and the relevant literature we have several recommendations.…”

Effect of Altitude Level on Surgical Outcomes of Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity: A Multicentre Prospective Study

“…PMVT is a rare, life-threatening pathology associated with increased LSG compared with other bariatric procedures. PMVT presentation after LSG is multifactorial and may be associated with genetics, hypercoagulability, acquired thrombophilia, sedentary lifestyle, which lead to blood flow reduction in the lower extremities 28–33. High altitude increased the risk of VTE after LSG for morbidly obese patients.…”

“…PMVT presentation after LSG is multifactorial and may be associated with genetics, hypercoagulability, acquired thrombophilia, sedentary lifestyle, which lead to blood flow reduction in the lower extremities. [28][29][30][31][32][33] High altitude increased the risk of VTE after LSG for morbidly obese patients. The National Health and Medical Research Council recommends extending LMWH prophylaxis for up to 28 days in high-risk patients who undergo abdominal or pelvic cancer surgery.…”

Direct oral anticoagulants after bariatric surgery—What is the evidence?

“…We identified 2519 records through database searches, http://clinicaltrials.gov, and reference lists (Figure 1). Twenty‐eight studies were included: 7 cohort studies, 6 case series, and 15 case reports 15–42 . Study characteristics can be found in Table 2.…”