Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy

Strong AT 1 , Sharma G 1 , Nor Hanipah Z 2 , Tu C 3 , Brethauer SA 4 , Schauer PR 4 Show all authors , Cetin D 5 , Aminian A 6

Affiliations 

  • 1 Department of General Surgery; Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
  • 2 Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
  • 3 Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
  • 4 Department of General Surgery; Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
  • 5 Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
  • 6 Department of General Surgery; Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: aminiaa@ccf.org
Surg Obes Relat Dis, 2018 05;14(5):700-706.
PMID: 29496441 DOI: 10.1016/j.soard.2017.12.021

Abstract

BACKGROUND: Warfarin dosing after bariatric surgery may be influenced by alterations in gastrointestinal pH, transit time, absorptive surface area, gut microbiota, food intake, and adipose tissue.

OBJECTIVES: The aim of this study was to describe trends in warfarin dosing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

SETTING: Single academic center.

METHODS: All patients chronically on warfarin anticoagulation before RYGB or SG were retrospectively identified. Indications for anticoagulation, history of bleeding or thrombotic events, perioperative complications, and warfarin dosing were collected.

RESULTS: Fifty-three patients (RYGB n = 31, SG n = 22) on chronic warfarin therapy were identified (56.6% female, mean 54.4 ± 11.7 yr of age). Of this cohort, 34.0% had prior venous thromboembolic events, 43.4% had atrial fibrillation, and 5.7% had mechanical cardiac valves. Preoperatively, the average daily dose of warfarin was similar in the RYGB group (8.3 ± 4.1 mg) and SG group (6.9 ± 2.8 mg). One month after surgery, mean daily dose of warfarin was reduced 24.1% in the RYGB group (P

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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