Absorption of DOACs in individuals who have undergone bariatric surgery

DOAC	Site(s) of absorption	Bariatric procedure effects
DOAC	Site(s) of absorption	Gastric banding	Partial/sleeve gastrectomy	RYGB
Apixaban	Primarily upper GI tract Possible limited absorption in the colon Absorption decreased when delivered to the distal small bowel	Unlikely affected	Unlikely affected	Possibly reduced
Dabigatran	Lower stomach and proximal small intestine	Possibly reduced
Edoxaban	Proximal small intestine Requires acidic environment
Rivaroxaban	Primarily stomach Some in the small intestine Absorption decreased when delivered distal to the stomach

This table refers to DOAC use in individuals who have undergone bariatric procedures but does not apply to the immediate post-surgical period. Close consultation between all clinical teams is prudent in determining the optimal approach. Refer to product information and additional discussion in UpToDate.

DOAC: direct oral anticoagulant; GI: gastrointestinal; RYGB: Roux-en-Y gastric bypass.

From: Martin KA, Beyer-Westendorf J, Davidson BL, et al. Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: Updated communication from the ISTH SSC Subcommittee on Control of Anticoagulation. J Thromb Haemost 2021; 19:1874. https://onlinelibrary.wiley.com/doi/10.1111/jth.15358. Copyright © 2021 John Wiley & Sons Ltd. Adapted with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).

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Absorption of DOACs in individuals who have undergone bariatric surgery