From the Guidelines
Oral anticoagulation in post-gastrectomy patients should be resumed 2-3 days after surgery with a reduced dose of dabigatran (110-150 mg once daily), rivaroxaban (10 mg once daily), or apixaban (2.5 mg twice daily) for patients at high risk for thromboembolism, as suggested by the management approach outlined in Table 5 of the study by 1. When considering oral anticoagulation in post-gastrectomy patients, it is essential to weigh the risks of bleeding against the benefits of preventing thromboembolic events. The study by 1 provides a suggested management approach for resuming new oral anticoagulants after surgery, taking into account the type of surgery and the patient's risk for thromboembolism. Some key points to consider when managing oral anticoagulation in post-gastrectomy patients include:
- The type of surgery, with high bleeding risk surgeries requiring a more cautious approach to anticoagulation resumption
- The patient's individual risk factors for thromboembolism, which may influence the choice of anticoagulant and dosing strategy
- The potential for altered drug absorption due to changes in gastric anatomy and physiology after gastrectomy
- The need for regular monitoring for bleeding complications, particularly in the first few weeks after surgery
- The importance of patient education on potential bleeding signs and the consistent use of anticoagulants with respect to meals to maintain steady absorption. In general, the choice of anticoagulant and dosing strategy should be individualized based on the specific clinical context and patient characteristics, with a focus on minimizing the risk of bleeding while preventing thromboembolic events.
From the Research
Oral Anticoagulations on Post Gastrectomy Patients
- The use of direct oral anticoagulants (DOACs) in patients after gastrectomy has been studied in several research papers 2, 3, 4, 5, 6.
- A study published in 2022 found that DOACs, particularly factor Xa inhibitors, were adequately absorbed in cancer patients after gastrectomy 2.
- However, another study published in 2017 advised avoidance of rivaroxaban therapy in patients undergoing gastrectomy due to uncertainty about its efficacy 3.
- Research on apixaban, a type of DOAC, has shown that it is safe and effective in preventing thromboembolic events in post-bariatric patients, including those who have undergone sleeve gastrectomy or Roux-en-Y gastric bypass 4, 5.
- A study published in 2020 investigated the perioperative management of DOACs in patients undergoing gastroenterological surgery and found that elective surgery can be safely performed in patients receiving DOACs without heparin bridging 6.
- The studies suggest that DOACs can be used in patients after gastrectomy, but caution should be exercised when using certain types of DOACs, such as dabigatran, due to the risk of recurrent thromboembolic events 2.
- The choice of DOAC and its dosage should be carefully considered in patients after gastrectomy, taking into account the type of surgery, patient characteristics, and potential risks of bleeding and thromboembolic complications 2, 3, 6.