Abstract Number: PB2398
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Direct oral anticoagulants (DOACs) including the anti-Xa inhibitors apixaban, edoxaban and rivaroxaban are effective and safe for treatment of venous thromboembolism (VTE). They are absorbed in the upper gastrointestinal tract and in case of rivaroxaban must be taken with meals due to its lipophilicity. In patients after gastrectomy data on their absorption are scarce and anti-Xa inhibitors are generally not recommended. However, some clinical situations might prompt their use as they have advantages including lower bleeding rates and ease of application compared to vitamin-K-antagonists or heparin.
Aims: To evaluate the absorption rate of oral anti-Xa inhibitors in patients after gastrectomy and their clinical outcome.
Methods: We measured levels of anti-Xa inhibitors in plasma of three patients who required anticoagulation after total gastrectomy or Roux-en-Y bypass surgery. Chromogenic anti-Xa assays specifically calibrated for rivaroxaban and edoxaban (STA Liquid Anti-Xa, Diagnostica Stago) were used.
Results: Patients’ characteristics, medical history and anti-Xa levels at different time points are shown in table 1. All patients had anti-Xa levels well above the detection limit 2 hours after intake. In patient 2 edoxaban trough levels after 24 hours were below the detection limit. The patient was switched to rivaroxaban, with trough levels again close to the detection limit. Patient 3 had recurrent superficial venous thrombosis during vitamin-K-antagonists and edoxaban despite anti-Xa levels well within normally expected levels. He was switched to apixaban without recurrent phlebitis ever since. None of the patients had recurrent VTE during observation time of 13, 10 and 12 months.
Conclusions: In patients after gastrectomy, direct oral anti-Xa inhibitors are absorbed but levels may vary considerably. Systematic analyses with clinical endpoints are warranted to evaluate efficacy and safety in these patients.
| Baseline | 2 h after intake | 4 h after intake | 24 h after intake | |||||
| Pat 1 (female, 55 years, gastrectomy for gastric cancer, pulmonary embolism 5 days after surgery) | ||||||||
| Rivaroxaban (ng/mL) | < 20 | 351 | 143 | 168 | ||||
| Pat 2 (female, 37 years, gastrectomy for pancreatic cancer, incidental pulmonary embolism) | ||||||||
| Edoxaban (ng/mL) | 83 | 67 | < 20 | |||||
| Rivaroxaban (ng/mL) | 61 | 39 | 22 | |||||
| Pat 3 (male, 34 years, Roux-en-Y bypass, recurrent deep vein thrombosis) | ||||||||
| Edoxaban (ng/mL) | < 20 | 129 | 109 | |||||
[Patients’ characteristics, medical history and anti-Xa levels ]
To cite this abstract in AMA style:
Eischer L, Eichinger S, Quehenberger P, Kylre PA. Direct Oral anti-Xa Inhibitors for Treatment of Venous Thromboembolism after Gastrectomy: Report on 3 Cases [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/direct-oral-anti-xa-inhibitors-for-treatment-of-venous-thromboembolism-after-gastrectomy-report-on-3-cases/. Accessed September 24, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/direct-oral-anti-xa-inhibitors-for-treatment-of-venous-thromboembolism-after-gastrectomy-report-on-3-cases/