Efficacy and safety of direct oral anticoagulants (DOACs) for postoperative thromboprophylaxis in patients after bariatric surgery: a systematic review and meta-analysis.

Abstract

Bariatric surgery is effective for achieving substantial weight loss and improving metabolic comorbidities in patients with severe obesity. However, both obesity and bariatric surgery elevate the risk of thromboembolic events. Traditionally, venous thromboembolism (VTE) prophylaxis in individuals who undergo bariatric surgery has relied on heparins, particularly enoxaparin. Concerns regarding pharmacologic limitations linked to the adipose tissue-related impact on the drug's pharmacodynamics in high-BMI patients have led to increased interest in direct oral anticoagulants (DOACs) as a potential alternative. This systematic review and meta-analysis aimed to assess the efficacy and safety of DOACs for thromboprophylaxis in people undergoing bariatric surgery. We systematically searched PubMed, EMBASE, and Cochrane Central for studies evaluating DOAC use for VTE prophylaxis in bariatric surgery patients up to November 2024. Primary outcomes included thrombotic and bleeding event rates (classified as major or minor), with secondary outcomes including the prevalence of allergic reactions. Randomized controlled trials and observational studies were included. Study weights were calculated using the inverse variance method, with statistical analyses performed using R version 4.4.0 (R Foundation for Statistical Computing, Vienna, Austria). Seven studies with a total of 7706 patients were included. The incidence of thrombotic events post-surgery with DOAC use was .23% (95% CI: .14-.39). Major bleeding events were reported at .33% (95% CI: .11-1.03), minor bleeding at 1.27% (95% CI: .45-3.54), and allergic reactions at 1.33% (95% CI: .59-2.98). There was one reported death due to pulmonary embolism. These findings suggest a low incidence of adverse effects with DOAC use in this population. Our meta-analysis supports the use of DOACs as a safe and effective option for thromboprophylaxis in individuals undergoing bariatric surgery. Further research, including direct comparisons with enoxaparin, is needed to establish definitive guidelines for postoperative management.