30-Day Post-Discharge Prophylaxis with Rivaroxaban Prevents Porto-Mesenteric Venous Thrombosis Following Laparoscopic Sleeve Gastrectomy with great interest.
Swarts et al. conducted a retrospective cohort study with 292 consecutive patients undergoing laparoscopic sleeve gastrectomy (LSG) who were prescribed rivaroxaban (a direct oral
anticoagulant, DOAC) 10 mg daily for 30 days after discharge for preventing portomesenteric venous thrombosis (PMVT). They compared this group with a control group with no venous thromboembolism (VTE) prophylaxis. They concluded the 30-day post-discharge chemoprophylaxis regimen of rivaroxaban 10 mg daily to be safe and effective. Using this regimen, Swarts et al. reported zero PMVT events without an increased risk of bleeding. We believe that the conclusion is premature, and the discussion of the study is inadequate. Some studies and guidelines that could defend or contradict the use of rivaroxaban for patients undergoing bariatric metabolic surgery (BMS) considering the risk associated with oral DOAC use are not presented.