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Anti-Xa Levels in Morbidly Obese Patients Using Apixaban or Rivaroxaban, Before and After Bariatric Surgery
Background Despite limited evidence about the efficacy and safety of anticoagulation in patients post bariatric surgery, both vitamin K antagonists (VKA) and direct-acting oral anticoagulants (DOACs) are commonly prescribed. Aim To evaluate plasma anti-Xa levels of DOACs in morbidly obese (MO) patie...
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| Published in: | Obesity surgery 2022-03, Vol.32 (3), p.607-614 |
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| Main Authors: | , , , , , |
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| container_end_page | 614 |
| container_issue | 3 |
| container_start_page | 607 |
| container_title | Obesity surgery |
| container_volume | 32 |
| creator | Kok, Thom de Boer, Hans Witteman, Bart Hovens, Marcel van Luin, Matthijs Monajemi, Houshang |
| description | Background
Despite limited evidence about the efficacy and safety of anticoagulation in patients post bariatric surgery, both vitamin K antagonists (VKA) and direct-acting oral anticoagulants (DOACs) are commonly prescribed.
Aim
To evaluate plasma anti-Xa levels of DOACs in morbidly obese (MO) patients before and after a Roux-en-Y gastric bypass (RYGB) procedure.
Patients and Methods
Retrospective, cross-sectional, and longitudinal study of anti-Xa activity of apixaban or rivaroxaban in MO patients (
N
= 41).
Results
Preoperative analysis of plasma anti-Xa levels were within the normal range in patients using apixaban (
n
= 29; body mass index [BMI] 44.5 ± 5.1 kg/m
2
) as well as those using rivaroxaban (
n
= 12; BMI 42.6 ± 5.9 kg/m
2
). Postoperative anti-Xa levels of apixaban were all within the therapeutic range, whereas anti-Xa levels of rivaroxaban were subtherapeutic in nine out of 14 (64%) patients. Perioperative longitudinal follow-up in patients using apixaban (
n
= 18) showed no significant change in anti-Xa levels after RYGB.
Conclusion
Plasma anti-Xa levels of apixaban in MO patients remained within the therapeutic range up to a body weight of 144 kg. In patients using rivaroxaban, no statistically significant relation between anti-Xa levels and bodyweight was found. After RYGB, plasma anti-Xa levels of apixaban were unaffected, whereas plasma anti-Xa levels of rivaroxaban tended to become subtherapeutic. |
| doi_str_mv | 10.1007/s11695-021-05814-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2602642444</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2632035940</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-5c5278476e9295466fd8629f43856d72effc2c4232cad6981052ddfdbe26e1613</originalsourceid><addsrcrecordid>eNp9kUFv1DAQhS0EotvCH-CALHHhgIs9dhznuK2gIC0qAipxs5x4Urlkna2dVOTf13TbInHgNBrNN29G7xHySvBjwXn9Pguhm4pxEIxXRii2PCErUXPDuALzlKx4ozkzDcgDcpjzFS-kBnhODqQyAIKbFfm1jlNgPx3d4A0OmYZIv4ypDX5Y6HmLGelXNwWMU6YXOcRLut6F3651kY6Jfgs3Lo137Tt6gv2YkLro6bqfMNETl4KbUujo9zldYlpekGe9GzK-vK9H5OLjhx-nn9jm_Ozz6XrDOllXE6u6Cmqjao0NNJXSuvdGQ9MraSrta8C-76BTIKFzXjdG8Aq8732LoFFoIY_I273uLo3XM-bJbkPucBhcxHHOFjQHrUApVdA3_6BX45xi-a5QErisGsULBXuqS2POCXu7S2Hr0mIFt3-isPsobDHY3kVhl7L0-l56brfoH1cevC-A3AO5jGIx6O_t_8jeAvF-ky8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2632035940</pqid></control><display><type>article</type><title>Anti-Xa Levels in Morbidly Obese Patients Using Apixaban or Rivaroxaban, Before and After Bariatric Surgery</title><source>Springer Nature</source><creator>Kok, Thom ; de Boer, Hans ; Witteman, Bart ; Hovens, Marcel ; van Luin, Matthijs ; Monajemi, Houshang</creator><creatorcontrib>Kok, Thom ; de Boer, Hans ; Witteman, Bart ; Hovens, Marcel ; van Luin, Matthijs ; Monajemi, Houshang</creatorcontrib><description>Background
Despite limited evidence about the efficacy and safety of anticoagulation in patients post bariatric surgery, both vitamin K antagonists (VKA) and direct-acting oral anticoagulants (DOACs) are commonly prescribed.
Aim
To evaluate plasma anti-Xa levels of DOACs in morbidly obese (MO) patients before and after a Roux-en-Y gastric bypass (RYGB) procedure.
Patients and Methods
Retrospective, cross-sectional, and longitudinal study of anti-Xa activity of apixaban or rivaroxaban in MO patients (
N
= 41).
Results
Preoperative analysis of plasma anti-Xa levels were within the normal range in patients using apixaban (
n
= 29; body mass index [BMI] 44.5 ± 5.1 kg/m
2
) as well as those using rivaroxaban (
n
= 12; BMI 42.6 ± 5.9 kg/m
2
). Postoperative anti-Xa levels of apixaban were all within the therapeutic range, whereas anti-Xa levels of rivaroxaban were subtherapeutic in nine out of 14 (64%) patients. Perioperative longitudinal follow-up in patients using apixaban (
n
= 18) showed no significant change in anti-Xa levels after RYGB.
Conclusion
Plasma anti-Xa levels of apixaban in MO patients remained within the therapeutic range up to a body weight of 144 kg. In patients using rivaroxaban, no statistically significant relation between anti-Xa levels and bodyweight was found. After RYGB, plasma anti-Xa levels of apixaban were unaffected, whereas plasma anti-Xa levels of rivaroxaban tended to become subtherapeutic.</description><identifier>ISSN: 0960-8923</identifier><identifier>EISSN: 1708-0428</identifier><identifier>DOI: 10.1007/s11695-021-05814-y</identifier><identifier>PMID: 34822108</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Anticoagulants ; Body mass index ; Gastrointestinal surgery ; Medicine ; Medicine & Public Health ; Original Contributions ; Plasma ; Surgery</subject><ispartof>Obesity surgery, 2022-03, Vol.32 (3), p.607-614</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-5c5278476e9295466fd8629f43856d72effc2c4232cad6981052ddfdbe26e1613</citedby><cites>FETCH-LOGICAL-c375t-5c5278476e9295466fd8629f43856d72effc2c4232cad6981052ddfdbe26e1613</cites><orcidid>0000-0002-4025-6102</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34822108$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kok, Thom</creatorcontrib><creatorcontrib>de Boer, Hans</creatorcontrib><creatorcontrib>Witteman, Bart</creatorcontrib><creatorcontrib>Hovens, Marcel</creatorcontrib><creatorcontrib>van Luin, Matthijs</creatorcontrib><creatorcontrib>Monajemi, Houshang</creatorcontrib><title>Anti-Xa Levels in Morbidly Obese Patients Using Apixaban or Rivaroxaban, Before and After Bariatric Surgery</title><title>Obesity surgery</title><addtitle>OBES SURG</addtitle><addtitle>Obes Surg</addtitle><description>Background
Despite limited evidence about the efficacy and safety of anticoagulation in patients post bariatric surgery, both vitamin K antagonists (VKA) and direct-acting oral anticoagulants (DOACs) are commonly prescribed.
Aim
To evaluate plasma anti-Xa levels of DOACs in morbidly obese (MO) patients before and after a Roux-en-Y gastric bypass (RYGB) procedure.
Patients and Methods
Retrospective, cross-sectional, and longitudinal study of anti-Xa activity of apixaban or rivaroxaban in MO patients (
N
= 41).
Results
Preoperative analysis of plasma anti-Xa levels were within the normal range in patients using apixaban (
n
= 29; body mass index [BMI] 44.5 ± 5.1 kg/m
2
) as well as those using rivaroxaban (
n
= 12; BMI 42.6 ± 5.9 kg/m
2
). Postoperative anti-Xa levels of apixaban were all within the therapeutic range, whereas anti-Xa levels of rivaroxaban were subtherapeutic in nine out of 14 (64%) patients. Perioperative longitudinal follow-up in patients using apixaban (
n
= 18) showed no significant change in anti-Xa levels after RYGB.
Conclusion
Plasma anti-Xa levels of apixaban in MO patients remained within the therapeutic range up to a body weight of 144 kg. In patients using rivaroxaban, no statistically significant relation between anti-Xa levels and bodyweight was found. After RYGB, plasma anti-Xa levels of apixaban were unaffected, whereas plasma anti-Xa levels of rivaroxaban tended to become subtherapeutic.</description><subject>Anticoagulants</subject><subject>Body mass index</subject><subject>Gastrointestinal surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Contributions</subject><subject>Plasma</subject><subject>Surgery</subject><issn>0960-8923</issn><issn>1708-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kUFv1DAQhS0EotvCH-CALHHhgIs9dhznuK2gIC0qAipxs5x4Urlkna2dVOTf13TbInHgNBrNN29G7xHySvBjwXn9Pguhm4pxEIxXRii2PCErUXPDuALzlKx4ozkzDcgDcpjzFS-kBnhODqQyAIKbFfm1jlNgPx3d4A0OmYZIv4ypDX5Y6HmLGelXNwWMU6YXOcRLut6F3651kY6Jfgs3Lo137Tt6gv2YkLro6bqfMNETl4KbUujo9zldYlpekGe9GzK-vK9H5OLjhx-nn9jm_Ozz6XrDOllXE6u6Cmqjao0NNJXSuvdGQ9MraSrta8C-76BTIKFzXjdG8Aq8732LoFFoIY_I273uLo3XM-bJbkPucBhcxHHOFjQHrUApVdA3_6BX45xi-a5QErisGsULBXuqS2POCXu7S2Hr0mIFt3-isPsobDHY3kVhl7L0-l56brfoH1cevC-A3AO5jGIx6O_t_8jeAvF-ky8</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Kok, Thom</creator><creator>de Boer, Hans</creator><creator>Witteman, Bart</creator><creator>Hovens, Marcel</creator><creator>van Luin, Matthijs</creator><creator>Monajemi, Houshang</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4025-6102</orcidid></search><sort><creationdate>20220301</creationdate><title>Anti-Xa Levels in Morbidly Obese Patients Using Apixaban or Rivaroxaban, Before and After Bariatric Surgery</title><author>Kok, Thom ; de Boer, Hans ; Witteman, Bart ; Hovens, Marcel ; van Luin, Matthijs ; Monajemi, Houshang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-5c5278476e9295466fd8629f43856d72effc2c4232cad6981052ddfdbe26e1613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anticoagulants</topic><topic>Body mass index</topic><topic>Gastrointestinal surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Contributions</topic><topic>Plasma</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kok, Thom</creatorcontrib><creatorcontrib>de Boer, Hans</creatorcontrib><creatorcontrib>Witteman, Bart</creatorcontrib><creatorcontrib>Hovens, Marcel</creatorcontrib><creatorcontrib>van Luin, Matthijs</creatorcontrib><creatorcontrib>Monajemi, Houshang</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Obesity surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kok, Thom</au><au>de Boer, Hans</au><au>Witteman, Bart</au><au>Hovens, Marcel</au><au>van Luin, Matthijs</au><au>Monajemi, Houshang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anti-Xa Levels in Morbidly Obese Patients Using Apixaban or Rivaroxaban, Before and After Bariatric Surgery</atitle><jtitle>Obesity surgery</jtitle><stitle>OBES SURG</stitle><addtitle>Obes Surg</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>32</volume><issue>3</issue><spage>607</spage><epage>614</epage><pages>607-614</pages><issn>0960-8923</issn><eissn>1708-0428</eissn><abstract>Background
Despite limited evidence about the efficacy and safety of anticoagulation in patients post bariatric surgery, both vitamin K antagonists (VKA) and direct-acting oral anticoagulants (DOACs) are commonly prescribed.
Aim
To evaluate plasma anti-Xa levels of DOACs in morbidly obese (MO) patients before and after a Roux-en-Y gastric bypass (RYGB) procedure.
Patients and Methods
Retrospective, cross-sectional, and longitudinal study of anti-Xa activity of apixaban or rivaroxaban in MO patients (
N
= 41).
Results
Preoperative analysis of plasma anti-Xa levels were within the normal range in patients using apixaban (
n
= 29; body mass index [BMI] 44.5 ± 5.1 kg/m
2
) as well as those using rivaroxaban (
n
= 12; BMI 42.6 ± 5.9 kg/m
2
). Postoperative anti-Xa levels of apixaban were all within the therapeutic range, whereas anti-Xa levels of rivaroxaban were subtherapeutic in nine out of 14 (64%) patients. Perioperative longitudinal follow-up in patients using apixaban (
n
= 18) showed no significant change in anti-Xa levels after RYGB.
Conclusion
Plasma anti-Xa levels of apixaban in MO patients remained within the therapeutic range up to a body weight of 144 kg. In patients using rivaroxaban, no statistically significant relation between anti-Xa levels and bodyweight was found. After RYGB, plasma anti-Xa levels of apixaban were unaffected, whereas plasma anti-Xa levels of rivaroxaban tended to become subtherapeutic.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>34822108</pmid><doi>10.1007/s11695-021-05814-y</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4025-6102</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0960-8923 |
| ispartof | Obesity surgery, 2022-03, Vol.32 (3), p.607-614 |
| issn | 0960-8923 1708-0428 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2602642444 |
| source | Springer Nature |
| subjects | Anticoagulants Body mass index Gastrointestinal surgery Medicine Medicine & Public Health Original Contributions Plasma Surgery |
| title | Anti-Xa Levels in Morbidly Obese Patients Using Apixaban or Rivaroxaban, Before and After Bariatric Surgery |
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