Rivaroxaban is effective and safe for thromboprophylaxis after bariatric surgery

Référence

Kröll D, Nett PC, Rommers N, et al. Efficacy and safety of rivaroxaban for postoperative thromboprophylaxis in patients after bariatric surgery. A randomized clinical trial. JAMA Network Open 2023;6(5):e2315241.

Sommaire

Patients undergoing bariatric surgery are at an increased risk for venous thromboembolism (VTE) because of severe obesity and perioperative immobility. Optimal VTE prophylaxis is uncertain. These investigators identified 272 adults, 18 years or older, undergoing bariatric surgery with a body mass index greater than 35 who were not at high risk for bleeding nor had a history of previous VTE. Eligible patients randomly received (concealed allocation assignment) rivaroxaban 10 mg orally once daily on postoperative day 1 for either 7 days (short group) or 28 days (long group) of thromboembolic prophylaxis. All patients underwent bilateral ultrasonography of both legs after 28 days by individuals masked to treatment group assignment. Spiral computed tomography was used to confirm pulmonary embolism when clinically suspected. Complete follow-up occurred for 98.9% of patients at 28 days. Using intention-to-treat analysis, only one primary efficacy VTE end point (an asymptomatic DVT) occurred — in a patient in the long group (0.4%; 95% CI 0.02% - 2.2%). Major or clinically relevant nonmajor bleeding events occurred in 5 patients (1.9%), including 2 in the short group and 3 in the long group (difference not significant).