Assessment of Warfarin Dosing Requirements After Bariatric Surgery in Patients Requiring Long‐Term Warfarin Therapy

Irwin, Adriane N.; McCool, Kathleen H.; Delate, Thomas; Witt, Daniel M.

doi:10.1002/phar.1307

Cited by 31 publications

(46 citation statements)

References 26 publications

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“…PK changes of medications have been exhibited in drugs, such as warfarin, where lower doses were required for the first 6 months postsurgery, and sertraline, which showed a significant decrease in area under the curve (AUC) and maximum serum concentration (Cmax) when compared between LRYGB patients and controls. Several studies have shown that this effect might be transient for some medications, such as duloxetine, midazolam, and more …”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery in solid organ transplant patients: Long-term follow-up results of outcome, safety, and effect on immunosuppression

Yemini

Nesher

Winkler

et al. 2018

American Journal of Transplantation

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The surgical risk of transplanted patients is high, and the modified gastrointestinal anatomy after bariatric surgery (BS) may lead to pharmacokinetic alterations in the absorption of immunosuppressive drugs. Data on outcomes of BS and the safety and feasibility of maintaining immunosuppression and graft safety among solid organ transplanted patients are scarce. In the current study, weight loss, improvement in comorbidities, and changes in dosage and trough levels of immunosuppression drugs before and after BS were analyzed for all transplanted patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between November 2011 and January 2017. Thirty-four patients (13 females, 21 males, average age 53 years) were included in the study. A successful weight loss (>50% excess weight loss in 28 of them [82%]) was recorded at the last follow-up. Comorbidities improved significantly. Immunosuppressive stability increased from 39% to 47% among all patients. The tacrolimus blood trough levels declined slightly, but remained within therapeutic range. These data suggest that LSG and LRYGB ensure good immunosuppressive maintenance together with significant weight loss and improvement in comorbidities without serious graft rejection or dysfunction. The surgical risk is higher than in the regular BS population.

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Section: Discussionmentioning

confidence: 99%

Bariatric surgery in solid organ transplant patients: Long-term follow-up results of outcome, safety, and effect on immunosuppression

Yemini

Nesher

Winkler

et al. 2018

American Journal of Transplantation

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“…She was again stabilized only after 10 days and a twofold increase in the daily dose . In contrast, a retrospective matched‐cohort study reported reduced daily doses of warfarin in patients following RYGB surgery, although doses were returned to normal after 6 months . After the surgery, dietary changes with reduced ingestion of vitamin K containing foods, weight loss and changes to the GI tract may play a role in alteration of warfarin efficacy and consequently, INR changes.…”

Section: The Effect Of Bariatric Surgeries On the Absorption Of Variomentioning

confidence: 98%

Oral drug therapy following bariatric surgery: an overview of fundamentals, literature and clinical recommendations

et al. 2016

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Bariatric surgery is the most effective solution for severe obesity and obesity with comorbidities, and the number of patients going through bariatric surgery is rapidly and constantly growing. The modified gastrointestinal anatomy of the patient may lead to significant pharmacokinetic alterations in the oral absorption of drugs after the surgery; however, because of insufficient available literature and inadequate awareness of the medical team, bariatric surgery patients may be discharged from the hospital with insufficient instructions regarding their medication therapy. In this article, we aim to present the various mechanisms by which bariatric surgery may influence oral drug absorption, to provide an overview of the currently available literature on the subject, and to draw guidelines for the recommendations bariatric surgery patients should be instructed before leaving the hospital. To date, and until more robust data are published, it is essential to follow and monitor patients closely for safety and efficacy of their medication therapies, both in the immediate and distant time post-surgery.

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“…One study compared warfarin dosing in 27 patients before and after bariatric surgery (82% post- RYGB and 18% post- GB) to a matched control group of 59 patients undergoing alternative abdominal surgeries 37 . A significant reduction in the median weekly dose of warfarin after bariatric surgery was found, ranging from 7.7 mg/week decrease at days 8–14 after surgery to a 30 mg/week decrease at days 50–56 (p<0.01), though the absolute change in dosing for individual patients varied substantially, ranging from 0 to 40 mg/week in the three months following surgery.…”

Section: Clinical Datamentioning

confidence: 99%

Oral Anticoagulant Use After Bariatric Surgery: A Literature Review and Clinical Guidance

Martin

Lee

Farrell

et al. 2017

The American Journal of Medicine

100

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Bariatric surgery may alter the absorption, distribution, metabolism and/or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of presently available data, it appears most prudent to use warfarin with INR monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery.

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Assessment of Warfarin Dosing Requirements After Bariatric Surgery in Patients Requiring Long‐Term Warfarin Therapy

Cited by 31 publications

References 26 publications

Bariatric surgery in solid organ transplant patients: Long-term follow-up results of outcome, safety, and effect on immunosuppression

Bariatric surgery in solid organ transplant patients: Long-term follow-up results of outcome, safety, and effect on immunosuppression

Oral drug therapy following bariatric surgery: an overview of fundamentals, literature and clinical recommendations

Oral Anticoagulant Use After Bariatric Surgery: A Literature Review and Clinical Guidance

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