Aspirin responsiveness changes in obese patients following bariatric surgery

Norgard, Nicholas B; Monte, Scott V.; Fernandez, Stanley F.; Ma, Qing

doi:10.1111/1755-5922.12268

Cited by 11 publications

(23 citation statements)

References 19 publications

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“…Although it was a small study, the authors conclude that patients were not at increased bleeding risk when using low-dose ASA 121 weeks after surgery whereas in controls, the IC50 level of ticagrelor was 14.5 nM. This suggests that bariatric surgery improves the ticagrelor pharmacodynamic response that was blunted by obesity, which is also showed in the study of Norgard described above 115 .…”

Section: Platelet Aggregation Inhibitorsmentioning

confidence: 62%

“…After surgery, the platelet reactivity was significantly reduced (432 ± 143 vs. 469 ± 60 ARU p=0.03), which was also seen in RYGB patients who did not use ASA (602 ± 59 vs. 531 ± 78 ARU p=0.035). This shows that the reduced reactivity after surgery compared to preoperative values may not be solely related to ASA 115 .…”

Section: Platelet Aggregation Inhibitorsmentioning

confidence: 77%

“…To date, four studies have investigated the effect of bariatric surgery on the pharmacokinetic profile of platelet aggregation inhibitors. Three studies describe the effect of bariatric surgery on ASA 33,115,121 . The other study investigates the effect of surgery on the pharmacodynamics on ticagrelor 122 .…”

Section: Platelet Aggregation Inhibitorsmentioning

confidence: 99%

“…Norgard and colleagues studied the effect of bariatric surgery on the aspirin-induced platelet inhibition and subsequent platelet aggregability 115 . Ten patients undergoing bariatric surgery (8 RYGB and 2 SG) were administrated two 7-day courses of ASA, before and three months after surgery.…”

Section: Platelet Aggregation Inhibitorsmentioning

confidence: 99%

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Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Kingma

Burgers

Monpellier

et al. 2021

Brit J Clinical Pharma

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Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism, and/or elimination of drugs may be altered.The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group a specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advices for oral drug therapy after bariatric surgery implying that a risk assessment on a case-by-case basis is required for each drug.

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Section: Platelet Aggregation Inhibitorsmentioning

confidence: 62%

Section: Platelet Aggregation Inhibitorsmentioning

confidence: 77%

Section: Platelet Aggregation Inhibitorsmentioning

confidence: 99%

Section: Platelet Aggregation Inhibitorsmentioning

confidence: 99%

See 2 more Smart Citations

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Kingma

Burgers

Monpellier

et al. 2021

Brit J Clinical Pharma

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“…Subgroup analyses of large trials of antithrombotic drugs are based on a few participants with class ≥2 obesity, and outcome trials specifically recruiting moderately to severely obese patients are lacking. Uncontrolled, small studies with a pre‐post design showed, that in subjects with class ≥3 obesity undergoing bariatric surgery, platelet responsiveness to aspirin (assessed in whole blood with the Verify Now assay, Accumetrics, San Diego, CA) improved after bariatric surgery and weight loss . Consistently, plasma levels of salicylic acid have been reported to increase after bariatric surgery and weight loss …”

Section: Introductionmentioning

confidence: 92%

Obesity is associated with impaired responsiveness to once‐daily low‐dose aspirin and in vivo platelet activation

Petrucci

Zaccardi

Giaretta

et al. 2019

Journal of Thrombosis and Haemostasis

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Background:The prevalence and degree of obesity is rising worldwide, increases cardiovascular risk, modifies body composition and organ function, and potentially affects the pharmacokinetics and/or pharmacodynamics of drugs. Objectives:To investigate the pharmacodynamics of once-daily low-dose aspirin in healthy obese subjects, and to assess whether body weight (BW) and body mass index (BMI) affect the pharmacology of aspirin.Patients/Methods: Otherwise healthy, obese (BMI > 30 kg/m 2 ) subjects were studied before and after 3-4 weeks of 100-mg once-daily aspirin intake. Aspirin pharmacodynamics were assessed according to serum thromboxane (TX) B 2 levels measured at 4 hours, 24 hours (i.e., posologic interval) and 48 hours after the last witnessed intake; agematched and sex-matched non-obese controls were included. A previously calibrated pharmacokinetic/pharmacodynamic in silico model of aspirin was used to fit serum TXB 2 data from obese subjects. At baseline, the major urinary TXA 2 and prostacyclin metabolites, urinary isoprostane and plasma inflammatory biomarkers were measured. Results:In 16 obese subjects (aged 47 ± 11 years; BMI of 39.4 ± 5.1 kg/m 2 ), residual serum TXB 2 values between 4 and 48 hours after aspirin intake were increased 3-to 5-fold as compared with controls. At 24 hours, the residual serum TXB 2 level was log-linearly associated with body size over a wide range of BMI and BW values, without any apparent threshold. The in silico model predicted that reduced aspirin bioavailability would be inversely related to body size and rescued by 200 mg of aspirin once daily or 85 mg twice daily. Baseline urinary TXA 2 metabolite, isoprostane and plasma C-reactive protein levels were significantly increased in obese subjects. Conclusions:Obesity is associated with impaired aspirin responsiveness, largely because of body size. Impaired inhibition of platelet activation by conventional lowdose aspirin may affect antithrombotic efficacy.

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Drug Related Complications After Bariatric Surgery

Huang

Liu

2021

Management of Nutritional and Metabolic Complications of Bariatric Surgery

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Aspirin responsiveness changes in obese patients following bariatric surgery

Abstract: Aspirin-induced platelet inhibition may be more potent following bariatric surgery. The mechanisms behind this improvement require further investigation.

Cited by 11 publications

References 19 publications

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Obesity is associated with impaired responsiveness to once‐daily low‐dose aspirin and in vivo platelet activation

Drug Related Complications After Bariatric Surgery

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