Rottenstreich A, et al. - The intent of the authors was to ascertain direct-acting oral anticoagulant (DOAC) blood levels in post-bariatric surgery (BS) patients treated with long-term anticoagulation therapy. A cautious use of all DOACs, especially rivaroxaban, was recommended following BS if used at all. Since vitamin-K antagonists could be easily monitored, they possibly served as a better choice, until additional data was available in terms of the DOAC use in this patient cohort.

Methods

• The study cohort comprised of patients who underwent BS during 2005-2016 and who were treated with DOACs.
• As a part of this research, testing of DOAC blood levels were offered to these patients and to age, sex, body mass index, and serum creatinine-matched individuals treated by DOACs who did not undergo BS.

Results

• Researchers recruited 36 individuals, 18 post-BS patients and 18 control subjects.
• Amongst the post-BS patients, 12 underwent laparoscopic sleeve gastrectomy, 4 laparoscopic adjustable gastric banding and 2 laparoscopic Roux-en-Y gastric bypass surgery.
• It was determined that the median time lapsed from surgery until study inclusion was 4.9 years.
• Herein, peak drug levels below expected levels were reported in 5 post-BS patients compared to none of the control subjects (P=0.05).
• The peak drug levels fell within the expected range for patients who used apixaban (n = 9) and dabigatran (n = 2).
• Meanwhile, the 7 patients who used rivaroxaban presented with levels taht were below the expected range in 5, with the inclusion of all four who underwent sleeve gastrectomy and one following adjustable gastric banding.
• Substantially lower peak rivaroxaban levels were disclosed in the post-BS than the control group (P=0.02).