Oral Anticoagulant Use After Bariatric Surgery: A Literature Review and Clinical Guidance

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

*Corresponding author for this work

Research output: Contribution to journalReview article

17 Scopus citations

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
Publication statusPublished - May 2017

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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)

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