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New research · Internal Medicine
Research and practice in thrombosis and haemostasis · 2h
ReviewResearch and practice in thrombosis and haemostasis · 2026

A review of the pharmacokinetics, pharmacodynamics, efficacy, and safety of direct oral anticoagulants in patients undergoing bariatric surgery.

Dino Kröll, Guido Stirnimann, Dereck Wentworth
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Internal MedicineReview

Rivaroxaban prophylaxis after bariatric surgery had low bleeding rates and no thrombosis

A review of the pharmacokinetics, pharmacodynamics, efficacy, and safety of direct oral anticoagulants in patients undergoing bariatric surgery.

Dino Kröll … Dereck Wentworth
Research and practice in thrombosis and haemostasis · 2026
Background

The role of direct oral anticoagulants for prevention of venous thromboembolism (venous thromboembolism) in bariatric surgery has been unclear.

Methods

Targeted literature reviews identified prospective studies of rivaroxaban ( n = 4) or apixaban ( n = 2) and retrospective studies ( n = 7) on venous thromboembolism prophylaxis in bariatric surgery.

n = 4
Results
1.9%
bleeding was rare and no clots occurred
n = 4
More results

Single-dose 10 mg rivaroxaban produced comparable systemic exposure before and after surgery, regardless of procedure type.

A noncontrolled, nonrandomized trial with risk-adapted dosing of rivaroxaban showed no thrombosis and low bleeding risk (0.9%).

More results

Single doses of 5 mg apixaban at 1, 6, and 12 months resulted in no clinically significant changes in pharmacokinetic and pharmacodynamic parameters.

A randomized controlled trial in sleeve gastrectomy patients with twice daily prophylactic apixaban or low-molecular-weight heparin resulted in no venous thromboembolism and low rates of bleeding events (2%).

“
Conclusion

Available evidence suggests that rivaroxaban and apixaban may be feasible options for thromboprophylaxis after bariatric surgery, although additional prospective studies are needed to confirm efficacy and safety.

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