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Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
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Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Factors Influencing Drug Absorption: Disease States and Pharmacology01:25

Factors Influencing Drug Absorption: Disease States and Pharmacology

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Multiple disease states can significantly influence the oral drug absorption process by affecting blood flow and the functionality of the gastrointestinal (GI) system. Various GI diseases, including conditions that alter GI motility, such as diarrhea, decreased acid secretions (achlorhydria), and infections, have been associated with reduced drug absorption.
Substances such as alcohol and specific drugs, including antineoplastics, can also negatively impact drug absorption. For instance,...
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Non-Oral Extravascular Drug Absorption Routes01:15

Non-Oral Extravascular Drug Absorption Routes

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Non-oral extravascular routes, which encompass sublingual, buccal, topical, intramuscular, and inhalation methods, primarily utilize passive diffusion to transport drugs into the systemic circulation. The absorption rates and effectiveness of these routes depend on the drug's physicochemical properties, as well as the patient's anatomical and pathophysiological state.
Lipophilic drugs that are stable at salivary pH (6) and exhibit minimal binding to the oral mucosa are absorbed more...
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Disorders of Hemostasis01:24

Disorders of Hemostasis

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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
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Inflammatory Bowel Disease I: Ulcerative Colitis01:27

Inflammatory Bowel Disease I: Ulcerative Colitis

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Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
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Updated: May 24, 2025

Myocardial Infarction by Percutaneous Embolization Coil Deployment in a Swine Model
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Pulmonary Infarction Due to Direct-acting Oral Anticoagulant Malabsorption.

Niroop Rajashekar1, Darius Mostaghimi1, Feng Jiang2

  • 1Yale School of Medicine.

Journal of Brown Hospital Medicine
|March 3, 2025
PubMed
Summary

Sleeve gastrectomy can cause rivaroxaban malabsorption, leading to recurrent venous thromboembolic events (VTE). This case highlights the need to consider malabsorption in patients with VTE despite anticoagulant use after bariatric surgery.

Keywords:
direct-acting oral anticoagulant failuremalabsorptionpulmonary infarctionrivaroxaban failure

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Area of Science:

  • Medical Case Study
  • Gastroenterology
  • Cardiology

Background:

  • A patient with a history of sleeve gastrectomy and multiple venous thromboembolic events (VTE) presented with persistent cough.
  • Initial treatment for presumed community-acquired pneumonia was ineffective.

Observation:

  • Initial chest CT revealed findings consistent with pneumonia, but symptoms persisted despite antibiotic treatment.
  • Re-evaluation of CT scans showed wedge-shaped opacities suggestive of pulmonary infarction.
  • Contrast-enhanced CT confirmed an increase in pulmonary embolism and acute-on-chronic thrombosis.

Findings:

  • Despite adherence to rivaroxaban and a negative hypercoagulable work-up, the patient experienced recurrent VTE.
  • Rivaroxaban malabsorption secondary to sleeve gastrectomy was identified as the cause of anticoagulant failure.

Implications:

  • Bariatric surgery, specifically sleeve gastrectomy, can impair the absorption of direct-acting oral anticoagulants (DOACs).
  • Malabsorption should be considered in patients with recurrent VTE despite DOAC therapy after bariatric surgery.
  • Warfarin therapy was successfully initiated, suggesting it as a viable alternative in such cases.