Plasmatic variability of direct oral anticoagulants in people with atrial fibrillation and previous gastric surgery: a pilot case series.

IF 2.7 4区医学 Q2 CLINICAL NEUROLOGY Neurological Sciences Pub Date : 2024-12-16 DOI:10.1007/s10072-024-07937-3

Michele Romoli, Maria Vitiello, Enrico Maria Lotti, Giuseppe D'Antuono, Arianna Berardo, Claudia Faini, Valentina Tudisco, Vincenzo Mastrangelo, Marco Longoni

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引用次数: 0

Abstract

Background: Data on cardioembolic prevention with direct oral anticoagulants (DOAC) in atrial fibrillation (AF) patients with previous gastric surgery are lacking. We report inter- and intra-individual differences in DOAC concentration in people with gastric surgery, to identify potential treatment options.

Methods: Patients with previous gastric surgery receiving DOAC for AF as stroke secondary prevention, and undergoing peak-trough DOAC plasmatic testing were selected from the regional EDDIE-AF registry. DOAC levels were tested at least 75-102 h after DOAC initiation with Siemens Innovance® assays.

Results: Eight patients with previous gastric surgery were included (mean age 75 years, 50% women). Overall, only 20/36 tests were within range (55.5%; apixaban 75.0%; dabigatran 0%; edoxaban 64.3%; rivaroxaban 33.3%). Rivaroxaban and dabigatran failed to reach therapeutic peak-trough concentrations. Apixaban and edoxaban reached therapeutic levels in 4/6 and 3/7 cases respectively, with marginal out-of-target concentrations in all remaining cases.

Conclusions: Our data support a consistent variability in DOAC absorption after gastric surgery, suggesting that implementation of DOAC plasmatic testing may help in ensuring therapeutic levels are met whenever DOACs are preferred over warfarin.

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来源期刊

Neurological Sciences 医学-临床神经学

CiteScore

6.10

自引率

3.00%

发文量

743

审稿时长

4 months

期刊介绍： Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.