From the Guidelines
Eliquis (apixaban) can be used in patients with atrial fibrillation who have had gastric bypass surgery, as it is primarily absorbed in the small intestine, which remains largely intact after most gastric bypass procedures 1.
Key Considerations
- The standard dosing for atrial fibrillation is typically 5 mg twice daily, though a reduced dose of 2.5 mg twice daily may be appropriate for patients meeting certain criteria (age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL) 1.
- Regular follow-up with both the cardiologist and bariatric surgeon is important to monitor for any signs of bleeding or thrombotic events.
- Blood tests to assess kidney function should be performed periodically, as renal function can impact Eliquis dosing and safety.
Recommendations
- According to the 2024 ESC guidelines, DOACs (apixaban, dabigatran, edoxaban, and rivaroxaban) are preferred over VKAs (warfarin and others), except in patients with mechanical heart valves and mitral stenosis 1.
- The CHA2DS2-VA score is recommended for assessment of stroke risk, and anticoagulant therapy should be individualized based on shared decision-making after discussion of the absolute risks and relative risks of stroke and bleeding, as well as the patient’s values and preferences 1.
Monitoring and Follow-up
- Patients should be consistent with their dosing schedule and take the medication with food.
- Regular monitoring of kidney function and bleeding risk is essential to ensure safe use of Eliquis.
- Periodic reassessment of therapy and attention to new modifiable risk factors can help slow or reverse the progression of AF, increase quality of life, and prevent adverse outcomes 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient with AFib and Gastric Bypass on Eliquis
- The use of Eliquis (apixaban) in patients with atrial fibrillation (AFib) who have undergone gastric bypass surgery is a topic of interest due to the potential effects of surgery on drug absorption 2.
- A study published in 2022 found that apixaban was safe and effective in preventing thromboembolic events in post-bariatric patients, including those who underwent Roux-en-Y gastric bypass 3.
- Another study from 2017 compared the effectiveness and safety of apixaban, dabigatran, rivaroxaban, and warfarin in newly diagnosed AFib patients, and found that apixaban had a favorable effectiveness, safety, and persistence profile 4.
- A case series published in 2021 reported that surgical resection or bypass of the upper gastrointestinal tract could affect the absorption of direct-acting oral anticoagulants (DOACs), including apixaban, but found that most patients who underwent total or partial gastrectomy achieved effective peak concentrations of apixaban 5.
- A systematic review and meta-analysis from 2013 found that NOACs, including apixaban, were associated with a lower risk of intracranial bleeding compared to warfarin in patients with non-valvular AFib 6.
- Overall, the available evidence suggests that apixaban can be used in patients with AFib who have undergone gastric bypass surgery, but clinicians should be aware of the potential effects of surgery on drug absorption and monitor patients closely 2, 3, 5.