Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy
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 byp...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018
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| Online Access: | http://psasir.upm.edu.my/id/eprint/73046/ http://psasir.upm.edu.my/id/eprint/73046/1/WARFARIN.pdf |
| _version_ | 1848857232264921088 |
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| author | Nor Hanipah, Zubaidah Strong, Andrew T. Sharma, Gautam Chao, Tu Brethauer, Stacy A. Schauer, Philip R. Cetin, Derrick Aminian, Ali |
| author_facet | Nor Hanipah, Zubaidah Strong, Andrew T. Sharma, Gautam Chao, Tu Brethauer, Stacy A. Schauer, Philip R. Cetin, Derrick Aminian, Ali |
| author_sort | Nor Hanipah, Zubaidah |
| building | UPM Institutional Repository |
| collection | Online Access |
| description | 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<.001) and 23.2% in the SG group (P = .002). At 12 months postoperatively, the required daily warfarin dose compared with baseline remained statistically different (RYGB: 6.8 ± 3.8 mg; SG: 6.1 ± 2.0 mg).
Conclusions: The warfarin dose is expected to be decreased by approximately 25% from preoperative levels after both RYGB and SG. Lower dose requirement within the first month after bariatric surgery is followed by a trend toward increased warfarin dose requirements, but remain less than baseline. Because dose requirements change constantly over time, frequent postoperative monitoring of the international normalized ratio is recommended. |
| first_indexed | 2025-11-15T11:54:17Z |
| format | Article |
| id | upm-73046 |
| institution | Universiti Putra Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T11:54:17Z |
| publishDate | 2018 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | upm-730462020-11-27T20:22:15Z http://psasir.upm.edu.my/id/eprint/73046/ Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy Nor Hanipah, Zubaidah Strong, Andrew T. Sharma, Gautam Chao, Tu Brethauer, Stacy A. Schauer, Philip R. Cetin, Derrick Aminian, Ali 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<.001) and 23.2% in the SG group (P = .002). At 12 months postoperatively, the required daily warfarin dose compared with baseline remained statistically different (RYGB: 6.8 ± 3.8 mg; SG: 6.1 ± 2.0 mg). Conclusions: The warfarin dose is expected to be decreased by approximately 25% from preoperative levels after both RYGB and SG. Lower dose requirement within the first month after bariatric surgery is followed by a trend toward increased warfarin dose requirements, but remain less than baseline. Because dose requirements change constantly over time, frequent postoperative monitoring of the international normalized ratio is recommended. Elsevier 2018 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/73046/1/WARFARIN.pdf Nor Hanipah, Zubaidah and Strong, Andrew T. and Sharma, Gautam and Chao, Tu and Brethauer, Stacy A. and Schauer, Philip R. and Cetin, Derrick and Aminian, Ali (2018) Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy. Surgery for Obesity and Related Diseases, 14 (5). 700 - 706. ISSN 1550-7289 https://pubmed.ncbi.nlm.nih.gov/29496441/ 10.1016/j.soard.2017.12.021 |
| spellingShingle | Nor Hanipah, Zubaidah Strong, Andrew T. Sharma, Gautam Chao, Tu Brethauer, Stacy A. Schauer, Philip R. Cetin, Derrick Aminian, Ali Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy |
| title | Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy |
| title_full | Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy |
| title_fullStr | Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy |
| title_full_unstemmed | Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy |
| title_short | Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy |
| title_sort | adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy |
| url | http://psasir.upm.edu.my/id/eprint/73046/ http://psasir.upm.edu.my/id/eprint/73046/ http://psasir.upm.edu.my/id/eprint/73046/ http://psasir.upm.edu.my/id/eprint/73046/1/WARFARIN.pdf |