Background: Bariatric surgery may impair the absorption of pharmaceutical agents. There are limited data on the absorption and effectiveness of direct oral anticoagulants (DOACs), including apixaban, dabigatran, edoxaban, and rivaroxaban, after bariatric surgery. Although case series have reported on DOAC levels post-bariatric surgery, there are no standardized tools available to assist clinicians in decision-making about continued use of these agents.

Aims: 1. Standardize the process of obtaining and interpreting DOAC levels after bariatric surgery. 2. Improve patient knowledge of DOAC use by the development of patient education tools.

Methods: A literature review was conducted using PubMed, CINAHL, and OVID databases for studies on the pharmacokinetic properties of DOACs including half-life, peak levels, expected steady-state and absorption site. Data was synthesized to create clinician/learner decision-making tools and patient education handouts.

Results: Multiple tools were developed as a result of this quality improvement project. Clinician/learner tools include a table summarizing the pharmacokinetic properties of DOACs and a decision-making tool for normal, high, and low peak DOAC level results. Patient education handouts were developed for each DOAC. Rationale for drug level checks and timing of bloodwork in relationship to DOAC administration were outlined. Patient adherence to instructions will be measured for each level drawn. We will use these tools to implement a standardized process to measure and interpret peak DOAC levels after bariatric surgery, to communicate with patients and to document our discussions.

Conclusions: There are few data supporting the efficacy and safety of DOACs after bariatric surgery. At St. Joseph’s Healthcare Hamilton, we developed multiple standardized tools to guide clinicians/learners in decision-making regarding DOAC use in this population. Ensuring adequate DOAC absorption post bariatric surgery is part of this multi-pronged approach in improving patient quality of care.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/direct-oral-anticoagulants-after-bariatric-surgery-a-quality-improvement-project/