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Long-Term Outcomes of Bariatric Surgery in Patients on Chronic Anticoagulation
Kamal Abi Mosleh1, Amanda Belluzzi1, Marita Salame1
1Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Insights
Patients on chronic anticoagulation therapy (CAT) undergoing metabolic and bariatric surgery (MBS) face higher bleeding risks, especially after Roux-en-Y gastric bypass (RYGB). Counseling on these risks and exploring alternatives to Warfarin is crucial.
Area of Science:
- Bariatric Surgery
- Cardiology
- Gastroenterology
Background:
- Metabolic and bariatric surgery (MBS) involves approximately 3% of patients on chronic anticoagulation therapy (CAT).
- Managing these patients requires balancing thrombosis and bleeding risks.
- Assessing long-term bleeding risk and anticoagulant dosing post-MBS is critical.
Purpose of the Study:
- To evaluate the long-term bleeding risk in patients undergoing MBS.
- To analyze trends in anticoagulant dosing after MBS.
Main Methods:
- A retrospective review of 132 patients (2008-2022) undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with preoperative CAT.
- Data collected included demographics, anticoagulation indication, type, and dosing.
- Bleeding events and concurrent CAT were assessed.
Main Results:
- Long-term bleeding incidence was significantly higher in the RYGB group (18.3%) versus the SG group (4%).
- Bleeding marginal ulcers (MU) were the most common cause in RYGB patients (13.4%).
- 84.2% of bleeding events occurred in patients on chronic Warfarin therapy.
Conclusions:
- Chronic anticoagulation therapy (CAT) increases bleeding risk in RYGB patients, particularly MU bleeds.
- Patients on CAT considering MBS require counseling on potential risks.
- Direct-acting oral anticoagulants may offer a safer alternative to Warfarin, warranting further research.
Background:
Approximately 3% of patients undergoing metabolic and bariatric surgery (MBS) are receiving chronic anticoagulation therapy (CAT) prior to operation. The management of these patients is complex, as it involves balancing the potential risk of thrombosis against that of bleeding. Our primary objective is to assess the long-term bleeding risk in patients undergoing MBS. We also aim to observe the trends in anticoagulant dosing after MBS.
Methods:
A single-center retrospective review of patients who underwent either primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with preoperative CAT between 2008 and 2022 was performed. Data on baseline demographics, indication for anticoagulation, type of CAT, and dosing were collected. Events of bleeding and the CAT at event were subsequently evaluated.
Results:
A total of 132 patients (82 RYGB and 50 SG) initially on CAT were identified, with atrial fibrillation being the most common indication. Incidence of long-term bleeding was significantly higher in the RYGB group (18.3%) compared to the SG group (4%) (p = 0.017) over a total of 5.2 ± 3.8 years. Bleeding marginal ulcer (MU) was the most common cause of bleeding in the RYGB group (13.4%). 84.2% of all bleeding events occurred in patients on chronic Warfarin therapy.
Conclusion:
Long-term CAT is associated with an increased risk of bleeding in RYGB patients, particularly MU bleeds. Patients on CAT seeking MBS should be counseled regarding this risk and potential implications. Direct-acting oral anticoagulants offer promise as an alternative to Warfarin in these patients; further research is necessary to better understand their safety.
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