Safety and Efficacy of Oral Anticoagulants for Atrial Fibrillation in Patients After Bariatric Surgery

Hendricks, Abby K.; Zieminski, Joseph J.; Yao, Xiaoxi; Dunlay, Shannon M.; Sangaralingham, Lindsey R.; O’Meara, John G.; Herrin, Theocles R.; Nei, Scott D

doi:10.1016/j.amjcard.2020.09.020

Cited by 7 publications

(13 citation statements)

References 17 publications

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“…Hendricks et al reported no difference in the occurrence of ischemic stroke/systemic embolism, major bleeding, and death between patients on DOAC and VKA in a bariatric cohort (n = 1673) [8]. In 29 bariatric patients on DOACs, investigators showed that bleeding events were common (29%), with a significant rate of thromboembolic events (7%); we recorded similar risks of those complications.…”

Section: Resultssupporting

confidence: 69%

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Direct oral anticoagulants in patients with atrial fibrillation following bariatric surgery: A single center experience

et al. 2021

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Section: Resultssupporting

confidence: 69%

“…Metabolism of vitamin K antagonists (VKA) seems to be less affected by bariatric surgery compared to direct oral anticoagulants (DOACs), and VKA may be a better choice in AF patients following such surgery [5,6]. A few studies on the effectiveness of DOACs in post-bariatric patients with AF yielded inconsistent results [7,8].…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants in patients with atrial fibrillation following bariatric surgery: A single center experience

et al. 2021

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“…Expected DOAC steady-state peak plasma concentrations from phase II and III clinical trials 15,58 separately for each DOAC. Sixteen studies reported clinical outcomes only (n = 3145 patients), [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] three reported pharmacokinetic outcomes only (n = 3 patients), [32][33][34] and nine reported both clinical and pharmacokinetic outcomes (n = 81 patients). 15,[35][36][37][38][39][40][41][42] Only one study 17 compared DOACs with warfarin in patients with non-valvular atrial fibrillation after bariatric surgery and did not show a statistically significant difference in the rate of stroke or systemic embolism, or major bleeding between the two interventions (Table S2).…”

Section: Ta B L Ementioning

confidence: 99%

“…One patient was initially treated with dabigatran then switched to apixaban. 41 All but one study 17…”

Section: What Is the Effi C Ac Y And Safe T Y Of Doac S Af Ter Bariat...mentioning

confidence: 99%

“…One patient was initially treated with dabigatran then switched to apixaban 41 . All but one study 17 reported outcomes separately for each DOAC. Sixteen studies reported clinical outcomes only ( n = 3145 patients), 16–31 three reported pharmacokinetic outcomes only ( n = 3 patients), 32–34 and nine reported both clinical and pharmacokinetic outcomes ( n = 81 patients) 15,35–42 .…”

Section: What Is the Efficacy And Safety Of Doacs After Bariatric Sur...mentioning

confidence: 99%

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Direct oral anticoagulants after bariatric surgery—What is the evidence?

Leong

Chu

Crowther

et al. 2022

Journal of Thrombosis and Haemostasis

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Background Obesity is a global epidemic and bariatric surgery is used with increasing frequency to treat its complications. The extent to which bariatric surgery alters the efficacy, safety, and pharmacokinetics of direct oral anticoagulants (DOACs) is unknown. Aims In this review, we summarize the evidence supporting the use of DOACs after bariatric surgery and apply our findings to resolve several clinical cases. Materials & Methods We systematically searched MEDLINE, EMBASE, Cochrane Library, CINAHL and http://clinicaltrials.gov from January 1, 2000, to June 15, 2021 for randomized and non‐randomized studies evaluating the use of DOACs for any indication after bariatric surgery. Two reviewers independently screened titles, abstracts, and full‐text articles. Clinical and pharmacokinetic outcomes were pooled by random‐effects meta‐analysis with inverse variance weighting. We used the Newcastle‐Ottawa scale to assess risk of bias in non‐randomized studies and assessed the certainty of evidence with GRADE. Results From 2519 records, we included 28 studies (n = 3229 patients): no randomized trials, 7 cohort studies, 6 case series, and 15 case reports. Incidence rates for arterial thromboembolism, venous thromboembolism and major bleeding were: 0.73 (95% confidence interval [CI]: 0.01–5.10), 2.45 (95% CI: 0.40–7.94), and 3.40 (95% CI: 0.80‐9.36) events per 100 patient‐years, respectively. The pooled proportion of peak direct oral anticoagulant drug levels within the expected range was 58% (95% CI: 39%–74%). Conclusion There appears be substantial risk of DOAC malabsorption after bariatric surgery that could affect clinical outcomes, however the certainty of evidence was very low. PROSPERO: CRD42020202636.

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Psychotropic Medications in Metabolic and Bariatric Surgery: Research Updates and Clinical Considerations

Coughlin

Steffen

Sockalingam

et al. 2022

Curr Psychiatry Rep

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Safety and Efficacy of Oral Anticoagulants for Atrial Fibrillation in Patients After Bariatric Surgery

Cited by 7 publications

References 17 publications

Direct oral anticoagulants in patients with atrial fibrillation following bariatric surgery: A single center experience

Direct oral anticoagulants in patients with atrial fibrillation following bariatric surgery: A single center experience

Direct oral anticoagulants after bariatric surgery—What is the evidence?

Psychotropic Medications in Metabolic and Bariatric Surgery: Research Updates and Clinical Considerations

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