Abstract
Background
Patients who undergo bariatric surgery have major physiologic changes in their gastrointestinal
tract, which can theoretically alter drug absorption and pharmacokinetics. This is
especially concerning for drugs with a narrow therapeutic index, as small changes
in absorption can have significant effects on safety and efficacy. One class of interest
is direct-acting oral anticoagulants (DOACs), for which there is a paucity of data
in this population.
Objective
To characterize the use of DOACs (apixaban, dabigatran, rivaroxaban) in patients with
a history of bariatric surgery and incidence of clotting and bleeding events.
Setting
Public healthcare system/university hospital, United States.
Methods
This retrospective cohort study included adult patients who were prescribed a DOAC
for the prophylaxis or treatment of venous thromboembolism or for stroke and systemic
embolism prevention in atrial fibrillation between January 2011 and December 2018.
Results
A total of 191 patients with a history of bariatric surgery were included. Clotting
events occurred in 11 of 191 patients (5.8%) receiving DOAC therapy, with a calculated
clotting rate of 3.9 clots per 100 person-years. Bleeding events occurred in 42 of
191 patients (22%) receiving a DOAC, with a calculated bleeding rate of 17.1 bleeds
per 100 person-years. The use of rivaroxaban versus apixaban was associated with a
statistically significant increased risk of bleeding in patients with a history of
bariatric surgery.
Conclusion
In this retrospective cohort of bariatric surgery patients receiving DOACs, we found
clotting rates consistent with expected rates and bleeding rates above expected rates
based on historical data. We also found an increased risk of bleeding in rivaroxaban
users compared with apixaban users. Careful evaluation of bleeding risks in bariatric
surgery patients is encouraged.
Keywords
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Article info
Publication history
Published online: September 21, 2022
Accepted:
September 5,
2022
Received:
March 18,
2022
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
