The effect of bariatric surgery on the direct oral anticoagulant rivaroxaban: the extension study.

Kröll, Dino; Nett, Philipp C.; Borbély, Yves Michael; Schädelin, Sabine; Bertaggia Calderara, Debora; Alberio, Lorenzo; Stirnimann, Guido (2018). The effect of bariatric surgery on the direct oral anticoagulant rivaroxaban: the extension study. Surgery for obesity and related diseases, 14(12), pp. 1890-1896. Elsevier 10.1016/j.soard.2018.08.025

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BACKGROUND Thromboembolic disease is a potentially serious complication in bariatric surgery patients. Direct oral anticoagulants (DOAC) have been investigated in orthopedic surgery patients. DOAC data after bariatric surgery are still limited to the early postsurgical period. Whether postsurgical midterm adaptations due to anatomic and physiologic alterations influence drug pharmacology is currently not known. OBJECTIVE The aim of this study was to investigate the influence of weight loss and type of bariatric surgery on midterm postsurgical pharmacokinetic and pharmacodynamic parameters of rivaroxaban. SETTING University hospital. METHODS In this monocentric study, bariatric patients received a single oral dose of rivaroxaban (10 mg) 6 to 8 months after sleeve gastrectomy (SG) or Roux-en-Y-gastric bypass (RYGB). Pharmacokinetic and pharmacodynamic parameters were assessed and compared with prebariatric surgery results. RESULTS We included 6 RYGB and 6 SG patients. Percent excess weight loss was 71.4% (interquartile range 56.4, 87.9) in the SG group and 76.6% (64.5, 85.7) in the RYGB group. Rivaroxaban mean areas under the curve 6 to 8 months after the bariatric procedure (922.4 µg × h/L, coefficient of variation 43.2) were comparable to those measured preoperatively (952.6 µg × h/L, 16.8). There was no relevant difference between the 2 surgical procedure groups. Rivaroxaban led to a decrease of prothrombin fragments F1+2 over 12 hours after oral intake confirming in vivo efficacy. CONCLUSIONS Significant weight loss and altered anatomy after RYGB and SG procedures do not appear to affect the pharmacokinetics and pharmacodynamics of prophylactic rivaroxaban. A single dose of Rivaroxaban was well tolerated and considered safe in this trial.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology

UniBE Contributor:

Kröll, Dino; Nett, Philipp C.; Borbély, Yves Michael and Stirnimann, Guido

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1550-7289

Publisher:

Elsevier

Language:

English

Submitter:

Thi Thao Anh Pham

Date Deposited:

11 Dec 2018 17:02

Last Modified:

07 Feb 2019 05:38

Publisher DOI:

10.1016/j.soard.2018.08.025

PubMed ID:

30396779

Uncontrolled Keywords:

Anticoagulants Bariatric surgery DOAC Obesity Rivaroxaban Thromboprophylaxis

BORIS DOI:

10.7892/boris.122080

URI:

https://boris.unibe.ch/id/eprint/122080

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