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Clinical Trial
. 2023 May 1;6(5):e2315241.
doi: 10.1001/jamanetworkopen.2023.15241.

Efficacy and Safety of Rivaroxaban for Postoperative Thromboprophylaxis in Patients After Bariatric Surgery: A Randomized Clinical Trial

Dino Kröll  1 , Philipp C Nett  1 , Nikki Rommers  2 , Yves Borbély  1 , Fabian Deichsel  3 , Antonio Nocito  3 , Jörg Zehetner  4 , Ulf Kessler  4 , Yannick Fringeli  4 , Lorenzo Alberio  5 , Daniel Candinas  1 , Guido Stirnimann  1
Affiliations
Clinical Trial

Efficacy and Safety of Rivaroxaban for Postoperative Thromboprophylaxis in Patients After Bariatric Surgery: A Randomized Clinical Trial

Dino Kröll et al. JAMA Netw Open. .

Abstract

Importance: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality after bariatric surgery. Clinical end point studies on thromboprophylaxis with direct oral anticoagulants in patients undergoing bariatric surgery are lacking.

Objective: To assess the efficacy and safety of a prophylactic dose of 10 mg/d of rivaroxaban for both 7 and 28 days after bariatric surgery.

Design, setting, and participants: This assessor-blinded, phase 2, multicenter randomized clinical trial was conducted from July 1, 2018, through June 30, 2021, with participants from 3 academic and nonacademic hospitals in Switzerland.

Intervention: Patients were randomized 1 day after bariatric surgery to 10 mg of oral rivaroxaban for either 7 days (short prophylaxis) or 28 days (long prophylaxis).

Main outcomes and measures: The primary efficacy outcome was the composite of deep vein thrombosis (symptomatic or asymptomatic) and pulmonary embolism within 28 days after bariatric surgery. Main safety outcomes included major bleeding, clinically relevant nonmajor bleeding, and mortality.

Results: Of 300 patients, 272 (mean [SD] age, 40.0 [12.1] years; 216 women [80.3%]; mean body mass index, 42.2) were randomized; 134 received a 7-day and 135 a 28-day VTE prophylaxis course with rivaroxaban. Only 1 thromboembolic event (0.4%) occurred (asymptomatic thrombosis in a patient undergoing sleeve gastrectomy with extended prophylaxis). Major or clinically relevant nonmajor bleeding events were observed in 5 patients (1.9%): 2 in the short prophylaxis group and 3 in the long prophylaxis group. Clinically nonsignificant bleeding events were observed in 10 patients (3.7%): 3 in the short prophylaxis arm and 7 in the long prophylaxis arm.

Conclusions and relevance: In this randomized clinical trial, once-daily VTE prophylaxis with 10 mg of rivaroxaban was effective and safe in the early postoperative phase after bariatric surgery in both the short and long prophylaxis groups.

Trial registration: ClinicalTrials.gov Identifier: NCT03522259.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Alberio reported receiving grants and personal fees from Bayer outside the submitted work and serving as a member of the Swiss Advisory Board for the clinical use of rivaroxaban in venous thromboembolism and of the Rivaroxaban Laboratory Monitoring in Switzerland Working Group. No other disclosures were reported.

Figures

Figure.
Figure.. Trial Profile
CUS indicates compression ultrasonography screening; ICF, informed consent form; mITT, modified intention to treat; and PP, per protocol.
See this image and copyright information in PMC

References

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