Effects of sleeve gastrectomy on rivaroxaban pharmacokinetics, efficacy, and safety

Thromboembolic events are potentially serious complications in patients undergoing bariatric surgery. Several studies have investigated the use of rivaroxaban in patients undergoing bariatric surgery. Further evidence is required to determine whether postsurgical anatomical and physiological changes affect the pharmacokinetics of rivaroxaban. This study aimed to investigate the pharmacokinetic, efficacy, and safety of rivaroxaban in patients who underwent sleeve gastrectomy surgery.

Included patients who admitted for sleeve gastrectomy surgery and were scheduled to receive prophylactic doses of rivaroxaban. Pre- and post-operative rivaroxaban plasma concentrations were determined. Efficacy and safety were assessed 6 and 9 months after surgery. Results: Twenty patients (40% males) were included in the study. The average body weight was 117.6 ± 21.2 kg. The average AUC values before, after, and 7-day after bariatric surgery were 5.83 (1.23), 5.34 (1.87), and 6.29 (2.12) μg·h mL^-1, respectively. The average C_max before, after, and 7-day after bariatric surgery were 0.45 (0.2), 0.37 (0.17), and 0.48 (0.23) μg mL^-1, respectively. No significant differences were observed in the rivaroxaban PK parameters. No thrombosis events were reported over 6 or 9 months. In addition, 100% of the participants experienced no significant bleeding events or other adverse effects associated with rivaroxaban during the trial period.

Rivaroxaban 10 mg shows promise as a potential medication for VTE prophylaxis after bariatric surgery. However, future studies with larger, more diverse populations are needed to confirm these findings and strengthen their applicability in clinical practice and to determine the optimal dosage and long-term safety profile in this patient population.