EP636 - Post-Discharge Anticoagulation and Gastrointestinal Bleeding After Minimally Invasive Colectomy: A Five-Year Review

Purpose/Background: Minimally invasive colon resections are associated with decreased postoperative complications compared with open surgery, including lower rates of wound infection (2.6-3.3% vs 5.1-5.8%), anastomotic leak (2.5-8.9% vs 6.1-11.1%), and bleeding (4-9.8% vs 9.7-10.8%). Venous thromboembolism (VTE) follows a similar trend, however extended post-discharge VTE prophylaxis remains the widely accepted standard for high-risk patients, though the risk of bleeding must be balanced against thrombotic events. Low-molecular-weight heparin (LMWH) has been the traditional agent used for post-discharge prophylaxis, but direct oral anticoagulants (DOACs) such as apixaban have emerged as an alternative with superior compliance and similar bleeding risk profiles.

Methods/Interventions: A retrospective review was performed using a prospectively maintained database of all colectomies (elective and urgent) performed by four colorectal surgeons between 2020 and 2025. A total of 1,146 colectomies were analyzed, with 1115 (95.7%) performed using a robotic approach. All patients received in-hospital VTE prophylaxis; those meeting criteria for extended VTE prophylaxis were discharged with LMWH or apixaban. Patients experiencing postoperative gastrointestinal bleeding (GIB) requiring readmission were identified, and surgical, perioperative, and prophylaxis variables were reviewed.

Results/Outcomes: Twenty-five patients (2.2%) developed postoperative GIB. Of these, ten (40%) were discharged on VTE prophylaxis - eight on apixaban and two on LMWH. Bleeding most commonly followed left-sided or rectal resections (60%). All events were managed non-operatively, with 68% requiring transfusion (median 1 unit). There were no reoperations or deaths among the extended VTE prophylaxis group. The overall incidence of GIB did not differ between patients receiving extended post-discharge DOAC prophylaxis and those not receiving extended anticoagulation. While not powered for statistical comparison, bleeding incidence was similar between patients with and without post-discharge prophylaxis.

Conclusion/Discussion: Postoperative gastrointestinal bleeding after minimally invasive colectomy remains uncommon and self-limited. The transition from LMWH to DOAC-based prophylaxis did not increase bleeding risk in this multi-surgeon series. DOACs appear to be a safe, practical, and patient-preferred alternative for extended VTE prophylaxis following minimally invasive colorectal surgery.