Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr;46(4):1715-1719.
doi: 10.1007/s10072-024-07937-3. Epub 2024 Dec 16.

Plasmatic variability of direct oral anticoagulants in people with atrial fibrillation and previous gastric surgery: a pilot case series

Michele Romoli  1 , Maria Vitiello  2 , Enrico Maria Lotti  3 , Giuseppe D'Antuono  4 , Arianna Berardo  5 , Claudia Faini  2   6 , Valentina Tudisco  2   7 , Vincenzo Mastrangelo  3 , Marco Longoni  2
Affiliations

Plasmatic variability of direct oral anticoagulants in people with atrial fibrillation and previous gastric surgery: a pilot case series

Michele Romoli et al. Neurol Sci. 2025 Apr.

Abstract

Background: Data on cardioembolic prevention with direct oral anticoagulants (DOAC) in atrial fibrillation (AF) patients with previous gastric surgery are lacking. We report inter- and intra-individual differences in DOAC concentration in people with gastric surgery, to identify potential treatment options.

Methods: Patients with previous gastric surgery receiving DOAC for AF as stroke secondary prevention, and undergoing peak-trough DOAC plasmatic testing were selected from the regional EDDIE-AF registry. DOAC levels were tested at least 75-102 h after DOAC initiation with Siemens Innovance® assays.

Results: Eight patients with previous gastric surgery were included (mean age 75 years, 50% women). Overall, only 20/36 tests were within range (55.5%; apixaban 75.0%; dabigatran 0%; edoxaban 64.3%; rivaroxaban 33.3%). Rivaroxaban and dabigatran failed to reach therapeutic peak-trough concentrations. Apixaban and edoxaban reached therapeutic levels in 4/6 and 3/7 cases respectively, with marginal out-of-target concentrations in all remaining cases.

Conclusions: Our data support a consistent variability in DOAC absorption after gastric surgery, suggesting that implementation of DOAC plasmatic testing may help in ensuring therapeutic levels are met whenever DOACs are preferred over warfarin.

Keywords: Anticoagulation; Direct oral anticoagulants; Gastric surgery; Precision medicine.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: Ethics Committee approval #8803/2019I.5/145, PI MR. Competing interests: None.

References

    1. Leong R, Chu DK, Crowther MA, Mithoowani S (2022) Direct oral anticoagulants after bariatric surgery—What is the evidence? J Thromb Haemost 20:1988–2000 - DOI - PubMed
    1. Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Vanassche T, Potpara T, Camm AJ, Heidbüchel H, Lip GYH, Deneke T, Dagres N, Boriani G, Chao TF et al (2021) 2021 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 23:1612–1676 - DOI - PubMed - PMC
    1. Siedler G, Macha K, Stoll S, Plechschmidt J, Wang R, Gerner ST, Strasser E, Schwab S, Kallmünzer B (2022) Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention. J Thromb Haemost 20:1138–1145. https://doi.org/10.1111/jth.15677
    1. Siedler G, Macha K, Stoll S, Plechschmidt J, Wang R, Gerner ST, Strasser E, Schwab S, Kallmünzer B (2022) Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention. J Thromb Haemost Elsevier Masson SAS 20:1138–1145 - DOI
    1. Gosselin R, Adcock D, Bates S, Douxfils J, Favaloro E, Gouin-Thibault I, Guillermo C, Kawai Y, Lindhoff-Last E, Kitchen S (2018) International Council for Standardization in Haematology (ICSH) recommendations for laboratory measurement of direct oral anticoagulants. Thromb Haemost 118:437–450 - DOI - PubMed

MeSH terms

LinkOut - more resources