Background

Thromboembolic events after sleeve gastrectomy (SG) are rare but morbid complications. The use of aspirin for chemoprophylaxis and its efficacy compared to low molecular weight heparin (LMWH) has been explored in other surgical populations. Here we studied the use of aspirin in low-risk patients after SG and its relationship to venous thromboembolism (VTE). This is a retrospective study assessing VTE following SG from 2021 to 2023. Caprini score was used to risk stratify patients. High-risk patients received extended chemoprophylaxis with LMWH (40 mg SC, 7-14 days). Sixteen months into the two-year period, aspirin (325 mg PO, 30 days) was initiated for low-risk patients postoperatively (phase 2). VTE events were analyzed using CUSUM, a statistical tool used in quality control to detect small deviations in a process. Prior to the initiation of aspirin for low-risk patients, 399 SG were performed, and 82 patients (20.6%) received LMWH. There was one MVT in a low-risk patient. During phase 2, 261 SG were performed, 57 (21.8%) received LMWH while 185 (70.8%) received aspirin alone. There were two MVT events in low-risk patients. CUSUM analysis demonstrated an initial reduction in VTE event rate with the administration of LMWH for high-risk patients and an increase in MVT event rate with the addition of aspirin for low-risk patients (Figure 1). The use of aspirin in patients at low risk for VTE following SG does not offer any benefit with regards to prevention. Furthermore, there may be an association between aspirin and the development of MVT.