Background

To Evaluate the Effectiveness of Extended Post Discharge VTE Prophylaxis using Eliquis (apixaban).Venous Thromboembolism (VTE) after bariatric surgery is a major cause of morbidity and mortality. Inpatient chemical prophylaxis is a common practice that decreases fatal pulmonary embolism. Many VTEs happen post-discharge. Extended chemical prophylaxis may decrease the incidence of post-discharge VTE.

Methods

In May, 2017 we started routinely prescribing apixaban 2.5mg bid for 1-month post-discharge from bariatric surgery in patients without a contraindication. Patients with absolute hematocrit decrease of >9% were not given apixiban. We evaluated our prospective data for adherence, significant post-discharge bleeding requiring readmission or transfusion, and VTE to 90 days.

Results

Between January 2014 and October 2021, 2779 patients underwent bariatric surgery. Of these 1,059 (38%) were prior to establishing the Eliquis protocol and 1,720 (62%) were after the apixaban protocol. Of the 1059 patients prior to apixaban, 4 (0.4%) experienced post discharge VTE. Of the 1720 patients after establishing the apixaban protocol there was one post-discharge VTE (0.06%) in a patient who did not get apixaban due to decreased post-op hct. (intent to treat p=0.054, treated p=.01). There were 2 (0.12%) readmissions for postoperative bleeding in patients on apixaban neither of whom required transfusion or re-operation.

Conclusions

Apixaban 2.5mg bid was well adhered to and tolerated with few bleeding complications and no related re-operations or transfusions. Apixaban appears to be safe and effective in significantly decreasing post-discharge VTE. Larger studies are warranted to confirm these findings.