Oral Anticoagulant Use After Bariatric Surgery: A Literature Review and Clinical Guidance.
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.
Division of Hematology/Oncology, University of North Carolina at Chapel Hill. Electronic address: Karlyn.martin@northwestern.edu.
Karlyn A
KA
Martin
Eshelman School of Pharmacy, University of North Carolina at Chapel Hill.
Craig R
CR
Lee
Division of Gastrointestinal Surgery, University of North Carolina at Chapel Hill.
Timothy M
TM
Farrell
Division of Hematology/Oncology, University of North Carolina at Chapel Hill.
Stephan
S
Moll
D065567:Absorption, Physiological; D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D050110:Bariatric Surgery; D001682:Biological Availability; D016903:Drug Monitoring; D002149:Energy Intake; D006801:Humans; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D015431:Weight Loss
D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
Absorption; Anticoagulation; Apixaban; Bariatric surgery; Biliopancreatic diversion; Bleeding; Dabigatran; Edoxaban; Efficacy; Gastrectomy; Gastric banding; Obesity; Pharmacokinetics; Rivaroxaban; Roux-en-Y; Safety; Thrombosis; Warfarin