Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Am J Cardiol. 2020 Dec 1;136:76-80. doi: 10.1016/j.amjcard.2020.09.020. Epub 2020 Sep 15.
Anticoagulation management is challenging in bariatric surgery patients, due to altered gastrointestinal anatomy and potentially reduced absorption. Few studies have evaluated clinical outcomes in this population. The objective of this study was to compare the efficacy and safety of oral anticoagulants in patients with and without a history of bariatric surgery. A retrospective, matched cohort study was conducted, utilizing data from the OptumLabs Data Warehouse. Patients ≥18 years old, with nonvalvular atrial fibrillation (NVAF), and treated with an oral anticoagulant between January 1, 2010 and December 31, 2018 were included. Outcomes were compared between bariatric and nonbariatric surgery patients. Secondary analysis compared warfarin to the direct oral anticoagulants (DOAC) in the bariatric cohort. The primary efficacy outcome was the rate of ischemic stroke and systemic embolism and the primary safety outcome was major bleeding. A total of 1,673 bariatric surgery and 155,619 nonbariatric surgery patients were identified. There was no significant difference in the rate of ischemic stroke or systemic embolism (0.83 vs 1.32 per 100 person years; Hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.31 to 1.22; p = 0.17) or major bleeding (5.30 vs 4.87 per 100 person years; HR 1.05, 95% CI 0.80 to 1.37; p = 0.73) between bariatric and nonbariatric surgery patients. In bariatric surgery patients alone, efficacy and safety were similar with warfarin compared with the DOACs. Results of this study suggest that bariatric surgery patients are not at an increased thrombotic or bleeding risk when using oral anticoagulants for NVAF. DOACs may be a reasonable alternative to warfarin.
在接受减重手术的患者中，抗凝管理具有挑战性，这是由于胃肠道解剖结构发生改变，且潜在的吸收能力降低。目前仅有少数研究评估了此类人群的临床结局。本研究的目的是比较有和无减重手术史的患者使用口服抗凝剂的疗效和安全性。本研究采用回顾性、匹配队列研究方法，使用来自 OptumLabs 数据仓库的数据。纳入年龄≥18 岁、患有非瓣膜性心房颤动（NVAF）且在 2010 年 1 月 1 日至 2018 年 12 月 31 日期间接受口服抗凝剂治疗的患者。比较了减重手术和非减重手术患者的结局。次要分析比较了华法林与减重手术队列中的直接口服抗凝剂（DOAC）。主要疗效结局为缺血性卒中和全身性栓塞的发生率，主要安全性结局为大出血。共纳入 1673 例减重手术和 155619 例非减重手术患者。缺血性卒中和全身性栓塞的发生率无显著差异（每 100 人年 0.83 比 1.32；风险比 [HR]0.62，95%置信区间 [CI]0.31 至 1.22；p=0.17）或大出血的发生率（每 100 人年 5.30 比 4.87；HR1.05，95%CI0.80 至 1.37；p=0.73）在减重手术和非减重手术患者之间。仅在减重手术患者中，与 DOAC 相比，华法林的疗效和安全性相似。本研究结果表明，对于 NVAF 患者，使用口服抗凝剂时，减重手术患者的血栓形成或出血风险并未增加。DOAC 可能是华法林的合理替代药物。
