IBC Oxford University Oral Abstract 51 - Comparison between low-molecular-weight heparin and apixaban for prophylaxis against venous thromboembolism after laparoscopic sleeve gastrectomy: a randomized controlled trial

Abstract Background Venous thromboembolism (VTE) is a possible complication after bariatric-metabolic surgery. Low-molecular-weight heparin (LMWH) is commonly used to prevent VTE, but there is limited data on the use of direct oral anticoagulants (DOACs). Apixaban, which is primarily absorbed in the proximal small bowel, may offer advantages over LMWH. Objectives This study aimed to assess the efficacy and safety of apixaban compared to LMWH for VTE prophylaxis after laparoscopic sleeve gastrectomy (LSG), by evaluating the incidence of VTE and bleeding. Methods This study was a randomized, single-blind, parallel-group (1:1) controlled clinical trial that enrolled 100 adult participants of both genders, aged 18 to 65 years who were scheduled for LSG at Cairo University Hospitals between August 2022 and January 2024. Subjects with severe obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities), normal preoperative human coagulation factor Xa serum level, and normal preoperative mesenteric, portal, splenic, and lower limb venous duplex were recruited. Exclusion criteria for this study included a history of bariatric surgery other than LSG, VTE/pulmonary embolism, or heart valve replacement, as well as pregnancy, lactation, and missed follow-up duplex. Participants were randomly assigned to one of two groups (50 patients each) using a computer-generated random sample table. Group A received postoperative prophylaxis with LMWH (1 mg/kg/day, max 120 mg/day) from day 1 to day 15, while G to day 15. Assessment of VTE was conducted on postoperative day 15 via venous duple roup B received postoperative prophylaxis with apixaban (2.5 mg twice daily) from day 1x of the mesenteric, splenic, portal, and lower limb veins. Results No statistically significant differences were observed between groups in VTE (0% incidence) or major postoperative bleeding (2% incidence). Conclusion Apixaban is as effective and safe as LMWH in preventing VTE after LSG, highlighting its potential role in this setting.