Abstract Number: LPB0002
Meeting: ISTH 2021 Congress
Background: Bariatric surgery likely impairs the absorption of direct oral anticoagulants (DOACs). The optimal DOAC after bariatric surgery is unclear.
Aims: To report on the safety and pharmacokinetics of DOACs after bariatric surgery in adults.
Methods: We systematically searched MEDLINE, EMBASE, Cochrane Library, CINAHL and ClinicalTrials.gov from Jan 2000-Jul 2020 for randomized and non-randomized studies. Two reviewers independently screened titles, abstracts and full-text articles. We used the Newcastle-Ottawa scale to assess risk of bias in non-randomized studies excluding case reports. This review was registered with PROSPERO (CRD42020202636).
Results: We screened 2,086 titles and abstracts and included 19 records (n=2,233 patients): no randomized trials, seven cohort studies, two case series, and ten case reports. Patients were taking DOACs for a variety of indications. Most studies had a moderate-high risk of bias. Of 2,123 patients taking apixaban, two (0.1%) developed venous thromboembolism (VTE) and six (0.3%) had major bleeding. Peak apixaban levels were measured in 13 patients (mean 182 ng/mL, 95% confidence interval [CI] 142-223 ng/mL); none were outside the therapeutic range seen in phase II studies. Of 94 patients taking rivaroxaban, two developed VTE (2.1%) and five (5.3%) had major bleeding. Peak rivaroxaban levels were measured in 17 patients (mean 249 ng/mL, 95% CI 162-336 ng/mL); eight (47%) were below and one (5.9%) was above the therapeutic range. Of 16 patients taking dabigatran, one patient (6.3%) each developed VTE, stroke and major bleeding. Peak dabigatran levels were measured in 12 patients (mean 57 ng/mL, 95% CI 22-91 ng/mL); nine (75%) were below and none were above the therapeutic range.
Conclusions: The preferred DOAC after bariatric surgery is uncertain. Additional cohort and registry studies are warranted given how frequently such patients require anticoagulant therapy.
To cite this abstract in AMA style:Leong R, K Chu D, A Crowther M, Mithoowani S. Safety and Pharmacokinetics of Direct Oral Anticoagulants after Bariatric Surgery: A Systematic Review [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/safety-and-pharmacokinetics-of-direct-oral-anticoagulants-after-bariatric-surgery-a-systematic-review/. Accessed May 20, 2022.
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