Impact of bariatric surgery on oral anticoagulants pharmacology, and consequences for clinical practice: a narrative review
| Autor: | Charles Roche, Cyril Leven, Clément Hoffmann, Francis Couturaud, Jérémie Thereaux, Karine Lacut |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Sleeve gastrectomy
medicine.medical_specialty Vitamin K medicine.medical_treatment Population Administration Oral Bariatric Surgery Pharmacology 030226 pharmacology & pharmacy Dabigatran 03 medical and health sciences 0302 clinical medicine Weight loss medicine Humans Pharmacology (medical) education education.field_of_study Rivaroxaban business.industry Warfarin Anticoagulants Atrial fibrillation medicine.disease Obesity Surgery Practice Guidelines as Topic medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Fundamental & Clinical Pharmacology. 35:53-61 |
| ISSN: | 1472-8206 0767-3981 |
| DOI: | 10.1111/fcp.12587 |
| Popis: | The prevalence of obesity has been steadily increasing in recent years worldwide. At the same time bariatric surgery, the best therapeutic strategy to date in terms of sustainable weight loss and improvement of associated comorbidities has been also increasing. However, these surgeries, whether primarily restrictive or malabsorptive, raise questions about the pharmacology of oral drugs. Among widely used drugs, anticoagulants are the referent therapy to treat some cardiovascular diseases such as atrial fibrillation and venous thromboembolism. How bariatric surgery may impact pharmacological properties of oral anticoagulants, and more specifically, direct oral anticoagulants (DOACs) are difficult to anticipate. In this review, we describe available data concerning the potential impact of bariatric surgery on the pharmacology of oral anticoagulants. The vitamin K antagonists (VKAs) requirements for the same international normalized ratio target are reduced after bariatric surgery. Limited data available for dabigatran 150 mg twice daily indicate a risk of insufficient efficacy in atrial fibrillation after gastric bypass due to probable impaired absorption. Data for rivaroxaban at the prophylactic dose of 10 mg per day suggest no impact of bariatric surgery from 3 days to 8 months post-surgery. However, no conclusive data are available for other anticoagulants or the use of DOACs at therapeutic doses. To date, DOACs are not recommended in patients who have undergone bariatric surgery, because of limited available data. Pending new studies to confirm the predictable pharmacokinetics and safety of DOACs in this population, especially at therapeutic doses, VKAs remain the first option for chronic anticoagulation. |
| Databáze: | OpenAIRE |
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