Oral Anticoagulant Use in Morbid Obesity and Post Bariatric Surgery: A Review - 20/12/21

Doi : 10.1016/j.amjmed.2021.07.017

Mohamed Farhan Nasser, MD ^a, Ahmad Jabri, MD ^a, Sanjay Gandhi, MD ^a,^⁎ , Florian Rader, MD ^b
^a Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
^b Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif

^⁎Requests for reprints should be addressed to Sanjay Gandhi, MD, Heart and Vascular Center, MetroHealth Medical Center / Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109.Heart and Vascular Center, MetroHealth Medical Center / Case Western Reserve University2500 Metrohealth DriveClevelandOH44109

Abstract

Bariatric surgery has emerged as a therapy for obesity and the associated comorbidities. Obesity has been shown to be a risk factor for atrial fibrillation as well as venous thromboembolism, both of which are conditions that warrant anticoagulation. There is significant underrepresentation of the morbidly obese population in prospective trials that evaluated direct oral anticoagulants and vitamin K antagonists in atrial fibrillation and venous thromboembolism. We aim to review all the available data that assessed these oral anticoagulants in the morbidly obese population (body mass index >40 kg/m² and weight >120 kg) and in the post-bariatric surgery population. Our findings suggest that direct oral anticoagulants may be safe and effective for anticoagulation in morbidly obese patients for both atrial fibrillation and venous thromboembolism. However, warfarin is the preferred agent in the post-bariatric surgery population, given the limited number of studies on direct oral anticoagulants in this population. Further adequately powered randomized control trials are needed to confirm the safety and efficacy of these oral anticoagulants in the morbidly obese and post-bariatric surgery population.

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Keywords : Bariatric surgery, Direct oral acting anticoagulant, Morbid obesity, Warfarin

Plan

Introduction

Risk Factors for Atrial Fibrillation and Venous Thromboembolism in Obesity

Anticoagulation and Morbid Obesity

Anticoagulation and Bariatric Surgery

Therapeutic Monitoring of DOACs

Conclusion

	Funding: None.
	Conflicts of Interest: None.
	Authorship: All the authors had a role in writing this manuscript. MFN: conceptualization, writing – original draft; AJ: writing – original draft; SG: writing – review & editing, supervision; FR: writing – review & editing, supervision.