Effect of major gastrointestinal tract surgery on the absorption and efficacy of direct acting oral anticoagulants (DOACs)
Review published in Journal of thrombosis and thrombolysis (2017)
Abstract
Direct-acting oral anticoagulants (DOACs) have been introduced as alternatives to warfarin for stroke prevention in non-valvular atrial fibrillation and for treatment of venous thromboembolism. Many patients undergoing major gastrointestinal resections or bypass receive anticoagulants for various indications, including the treatment of thrombotic complication of surgery and prevention of visceral vessels events recurrence. DOACs have a wide therapeutic range that allows fixed dosing determined based on studies conducted in healthy subjects with normal absorptive capacity. Patients with significantly altered gastrointestinal tracts were not included in the Phase II and III studies that assessed DOAC efficacy and safety. The aim of this article is to review clinical data on DOACs use in patients with major surgical resection or bypass. MEDLINE and EMBASE were searched to identify studies and case reports of DOAC use in this population. Prescribing information for the four approved DOACs was also reviewed. The only types of available literature identified were case series and isolated case reports. Patients who underwent major distal intestinal resection were successfully anticoagulated with rivaroxaban, dabigatran was not effective. There is uncertainty about the efficacy of rivaroxaban and dabigatran in patients requiring anticoagulation after Roux-en-Y gastric bypass. Avoidance of rivaroxaban therapy in patients undergoing gastrectomy is advised Data are lacking regarding anticoagulation using apixaban and edoxaban in patients with major gastrointestinal resection or bypass is lacking. Clinicians should be aware of these limitations when using DOACs in this group of patients.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Direct-acting oral anticoagulants (DOACs) have been introduced as alternatives to warfarin for stroke prevention in non-valvular atrial fibrillation and for treatment of venous thromboembolism.
Por qué esto importa para la hirudoterapia
This review examined clinical data on the use of direct-acting oral anticoagulants (DOACs)—specifically rivaroxaban, dabigatran, apixaban, and edoxaban—in patients who had undergone major gastrointestinal tract resection or bypass surgery, finding that available evidence is limited to case series and isolated case reports. Rivaroxaban appeared effective after distal intestinal resection while dabigatran was not; avoidance of rivaroxaban after gastrectomy was advised; and data on apixaban and edoxaban were lacking. The relevance to hirudotherapy or the leech secretome is essentially none: although DOACs and hirudin-derived anticoagulants share the broader pharmacological category of anticoagulants acting on thrombin or factor Xa, this review does not involve leeches, hirudin, or any leech-derived compound. No connection to ASH's domain is defensible beyond the most generic shared interest in anticoagulation pharmacology. Clinicians should not extrapolate any leech-related insight from this work.
Citación
Effect of major gastrointestinal tract surgery on the absorption and efficacy of direct acting oral anticoagulants (DOACs)
Hakeam HA et al. · Journal of thrombosis and thrombolysis, 2017
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026