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Anti-Xa Levels in Morbidly Obese Patients Using Apixaban or Rivaroxaban, Before and After Bariatric Surgery
Thom Kok1, Hans de Boer2, Bart Witteman3
1Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands. thom.kok9@gmail.com.
Obesity Surgery
|November 25, 2021
Summary
Direct-acting oral anticoagulants (DOACs) like apixaban maintain therapeutic levels post-bariatric surgery, but rivaroxaban may become subtherapeutic in morbidly obese patients after Roux-en-Y gastric bypass.
Area of Science:
- Pharmacology
- Bariatric Surgery
- Thrombosis Management
Background:
- Limited data exists on anticoagulation efficacy and safety post-bariatric surgery.
- Vitamin K antagonists (VKA) and direct-acting oral anticoagulants (DOACs) are frequently prescribed.
- Morbidly obese (MO) patients undergoing bariatric surgery present unique pharmacokinetic challenges.
Purpose of the Study:
- To evaluate plasma anti-factor Xa (anti-Xa) levels of DOACs in MO patients.
- To assess anti-Xa levels before and after Roux-en-Y gastric bypass (RYGB) surgery.
- To compare apixaban and rivaroxaban pharmacokinetics in this population.
Main Methods:
- Retrospective, cross-sectional, and longitudinal study design.
- Analysis of anti-Xa activity for apixaban and rivaroxaban in 41 MO patients.
- Measurement of plasma anti-Xa levels pre- and post-RYGB.
Main Results:
- Preoperative anti-Xa levels were therapeutic for both apixaban and rivaroxaban.
- Postoperative apixaban anti-Xa levels remained therapeutic.
- Postoperative rivaroxaban anti-Xa levels were subtherapeutic in 64% of patients.
Conclusions:
- Apixaban anti-Xa levels remain therapeutic post-RYGB, even in patients up to 144 kg.
- Rivaroxaban anti-Xa levels may become subtherapeutic after RYGB, with no clear weight correlation.
- These findings suggest potential differences in DOAC efficacy after bariatric surgery.
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