Background <p>Metabolic and bariatric surgery is linked to an increased risk of venous thromboembolism (VTE) and postoperative hemorrhage. Although thrombotic chemoprophylaxis is frequently provided to avert VTE, its impact on bleeding complications remains uncertain.</p> Objectives <p>This study intends to assess the effect of preoperative thrombotic chemoprophylaxis on the occurrence of postoperative hemorrhage in individuals undergoing sleeve gastrectomy.</p> Methods <p>A retrospective cohort study was conducted including 226 individuals who underwent sleeve gastrectomy at KHMC over a 2-year period. Patients were classified into two groups based on the provision of preoperative thromboprophylaxis. Demographic data, comorbidities, and postoperative outcomes were analyzed using descriptive and inferential statistics.</p> Results <p>Out of 226 patients, 149 (65.9%) underwent preoperative thromboprophylaxis. Postoperative bleeding occurred in 1.3% of patients. A statistically significant inverse association was identified between thromboprophylaxis and the installation of postoperative drains (<i>P</i> = 0.003). Nonetheless, no significant association was seen between thromboprophylaxis and postoperative bleeding following propensity-score matching (<i>P</i> = 1.00).</p> Conclusion <p>The preoperative administration of low-molecular-weight heparin (LMWH) did not substantially correlate with an elevated risk of postoperative hemorrhage. However its application was associated with a reduced incidence of postoperative drain placement. These findings enrich the expanding amount of research about the safety and outcomes of thrombotic chemoprophylaxis in metabolic and bariatric surgery.</p>