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Review
. 2017 May;130(5):517-524.
doi: 10.1016/j.amjmed.2016.12.033. Epub 2017 Feb 1.

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

Karlyn A Martin  1 , Craig R Lee  2 , Timothy M Farrell  3 , Stephan Moll  4
Affiliations
Review

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

Karlyn A Martin et al. Am J Med. 2017 May.

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.

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Conflict of interest statement

Conflict of interest: SM has consulted for Boehringer-Ingelheim and Janssen Pharmaceuticals.

Figures

Figure 1
Figure 1
A–D: Bariatric procedures. A: Roux-en-Y gastric bypass; B: Sleeve gastrectomy; C: Gastric banding. D: Biliopancreatic diversion with duodenal switch.
Figure 2
Figure 2
Location of absorption of anticoagulants
See this image and copyright information in PMC

Comment in

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