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
Esta revisión examinó datos clínicos sobre el uso de anticoagulantes orales de acción directa (ACOD)—específicamente rivaroxabán, dabigatrán, apixabán y edoxabán—en pacientes que habían sido sometidos a resección mayor del tracto gastrointestinal o cirugía de bypass, encontrando que la evidencia disponible se limita a series de casos y reportes de casos aislados. Rivaroxabán pareció eficaz tras resección intestinal distal, mientras que dabigatrán no lo fue; se aconsejó evitar rivaroxabán tras gastrectomía; y los datos sobre apixabán y edoxabán eran escasos. La relevancia para la hirudoterapia o el secretoma de la sanguijuela es esencialmente nula: aunque los ACOD y los anticoagulantes derivados de la hirudina comparten la categoría farmacológica más amplia de anticoagulantes que actúan sobre la trombina o el factor Xa, esta revisión no involucra sanguijuelas, hirudina ni ningún compuesto derivado de sanguijuela. No es defendible ninguna conexión con el ámbito de ASH más allá del interés genérico compartido en la farmacología de la anticoagulación. Los clínicos no deben extrapolar ninguna percepción relacionada con sanguijuelas a partir de este trabajo.
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
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026