Oral Anticoagulant Use After Bariatric Surgery

A Literature Review and Clinical Guidance

Karlyn A. Martin, Craig R. Lee, Timothy M. Farrell, Stephan Moll

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Bariatric surgery may alter the absorption, distribution, metabolism, or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited, and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of currently available data, it appears most prudent to use warfarin with international normalized ratio monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery.

Original languageEnglish (US)
Pages (from-to)517-524
Number of pages8
JournalAmerican Journal of Medicine
Volume130
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Bariatric Surgery
Anticoagulants
Pharmaceutical Preparations
International Normalized Ratio
Warfarin
Gastrointestinal Tract
Adipose Tissue
Anatomy
Body Weight
Safety
Therapeutics
Population

Keywords

  • Absorption
  • Anticoagulation
  • Apixaban
  • Bariatric surgery
  • Biliopancreatic diversion
  • Bleeding
  • Dabigatran
  • Edoxaban
  • Efficacy
  • Gastrectomy
  • Gastric banding
  • Obesity
  • Pharmacokinetics
  • Rivaroxaban
  • Roux-en-Y
  • Safety
  • Thrombosis
  • Warfarin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Martin, Karlyn A. ; Lee, Craig R. ; Farrell, Timothy M. ; Moll, Stephan. / Oral Anticoagulant Use After Bariatric Surgery : A Literature Review and Clinical Guidance. In: American Journal of Medicine. 2017 ; Vol. 130, No. 5. pp. 517-524.
@article{ce9db2aea3b947b19bc0f555fe2670ca,
title = "Oral Anticoagulant Use After Bariatric Surgery: A Literature Review and Clinical Guidance",
abstract = "Bariatric surgery may alter the absorption, distribution, metabolism, or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited, and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of currently available data, it appears most prudent to use warfarin with international normalized ratio monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery.",
keywords = "Absorption, Anticoagulation, Apixaban, Bariatric surgery, Biliopancreatic diversion, Bleeding, Dabigatran, Edoxaban, Efficacy, Gastrectomy, Gastric banding, Obesity, Pharmacokinetics, Rivaroxaban, Roux-en-Y, Safety, Thrombosis, Warfarin",
author = "Martin, {Karlyn A.} and Lee, {Craig R.} and Farrell, {Timothy M.} and Stephan Moll",
year = "2017",
month = "5",
day = "1",
doi = "10.1016/j.amjmed.2016.12.033",
language = "English (US)",
volume = "130",
pages = "517--524",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "5",

}

Oral Anticoagulant Use After Bariatric Surgery : A Literature Review and Clinical Guidance. / Martin, Karlyn A.; Lee, Craig R.; Farrell, Timothy M.; Moll, Stephan.

In: American Journal of Medicine, Vol. 130, No. 5, 01.05.2017, p. 517-524.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Oral Anticoagulant Use After Bariatric Surgery

T2 - A Literature Review and Clinical Guidance

AU - Martin, Karlyn A.

AU - Lee, Craig R.

AU - Farrell, Timothy M.

AU - Moll, Stephan

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Bariatric surgery may alter the absorption, distribution, metabolism, or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited, and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of currently available data, it appears most prudent to use warfarin with international normalized ratio monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery.

AB - Bariatric surgery may alter the absorption, distribution, metabolism, or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited, and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of currently available data, it appears most prudent to use warfarin with international normalized ratio monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery.

KW - Absorption

KW - Anticoagulation

KW - Apixaban

KW - Bariatric surgery

KW - Biliopancreatic diversion

KW - Bleeding

KW - Dabigatran

KW - Edoxaban

KW - Efficacy

KW - Gastrectomy

KW - Gastric banding

KW - Obesity

KW - Pharmacokinetics

KW - Rivaroxaban

KW - Roux-en-Y

KW - Safety

KW - Thrombosis

KW - Warfarin

UR - http://www.scopus.com/inward/record.url?scp=85014588519&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014588519&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2016.12.033

DO - 10.1016/j.amjmed.2016.12.033

M3 - Review article

VL - 130

SP - 517

EP - 524

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 5

ER -