Influences of Obesity and Bariatric Surgery on the Clinical and Pharmacologic Profile of Rivaroxaban
Abstract The health implications of obesity are myriad and multifaceted. Physiologic changes associated with obesity can affect the absorption, distribution, metabolism, and excretion of administered drugs, thereby altering their pharmacologic profiles. In 2016, the Scientific and Standardization Co...
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| Veröffentlicht in: | The American journal of medicine 2017-09, Vol.130 (9), p.1024-1032 |
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| creator | Moore, Kenneth Todd, MS Kröll, Dino, MD |
| description | Abstract The health implications of obesity are myriad and multifaceted. Physiologic changes associated with obesity can affect the absorption, distribution, metabolism, and excretion of administered drugs, thereby altering their pharmacologic profiles. In 2016, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis published recommendations regarding the use of direct oral anticoagulants (DOACs) in obese patients. This guidance provides uniform recommendations for all DOACs, yet data suggest that individual agents may be affected to different degrees by obesity. Moreover, there are no recommendations currently available to guide DOAC use in bariatric surgery patients, in whom anatomic and physiologic changes to the digestive system can influence drug pharmacokinetics. Our review of the available literature indicates that the clinical profile of the DOAC rivaroxaban is not affected by high weight or bariatric surgery; hence, it does not appear that rivaroxaban dosing needs to be altered in these patient populations. |
| doi_str_mv | 10.1016/j.amjmed.2017.05.011 |
| format | Article |
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Physiologic changes associated with obesity can affect the absorption, distribution, metabolism, and excretion of administered drugs, thereby altering their pharmacologic profiles. In 2016, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis published recommendations regarding the use of direct oral anticoagulants (DOACs) in obese patients. This guidance provides uniform recommendations for all DOACs, yet data suggest that individual agents may be affected to different degrees by obesity. Moreover, there are no recommendations currently available to guide DOAC use in bariatric surgery patients, in whom anatomic and physiologic changes to the digestive system can influence drug pharmacokinetics. Our review of the available literature indicates that the clinical profile of the DOAC rivaroxaban is not affected by high weight or bariatric surgery; hence, it does not appear that rivaroxaban dosing needs to be altered in these patient populations.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2017.05.011</identifier><identifier>PMID: 28601546</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anticoagulants ; Bariatric surgery ; Bariatric Surgery - adverse effects ; Bariatric Surgery - standards ; Factor Xa Inhibitors - administration & dosage ; Factor Xa Inhibitors - pharmacokinetics ; Factor Xa Inhibitors - standards ; Humans ; Internal Medicine ; Obesity ; Obesity, Morbid - complications ; Obesity, Morbid - metabolism ; Obesity, Morbid - surgery ; Practice Guidelines as Topic ; Rivaroxaban ; Rivaroxaban - administration & dosage ; Rivaroxaban - pharmacokinetics ; Rivaroxaban - standards ; Thromboprophylaxis ; Thrombosis - drug therapy ; Thrombosis - prevention & control</subject><ispartof>The American journal of medicine, 2017-09, Vol.130 (9), p.1024-1032</ispartof><rights>2017 The Authors</rights><rights>Copyright © 2017 The Authors. Published by Elsevier Inc. 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Physiologic changes associated with obesity can affect the absorption, distribution, metabolism, and excretion of administered drugs, thereby altering their pharmacologic profiles. In 2016, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis published recommendations regarding the use of direct oral anticoagulants (DOACs) in obese patients. This guidance provides uniform recommendations for all DOACs, yet data suggest that individual agents may be affected to different degrees by obesity. Moreover, there are no recommendations currently available to guide DOAC use in bariatric surgery patients, in whom anatomic and physiologic changes to the digestive system can influence drug pharmacokinetics. Our review of the available literature indicates that the clinical profile of the DOAC rivaroxaban is not affected by high weight or bariatric surgery; hence, it does not appear that rivaroxaban dosing needs to be altered in these patient populations.</description><subject>Anticoagulants</subject><subject>Bariatric surgery</subject><subject>Bariatric Surgery - adverse effects</subject><subject>Bariatric Surgery - standards</subject><subject>Factor Xa Inhibitors - administration & dosage</subject><subject>Factor Xa Inhibitors - pharmacokinetics</subject><subject>Factor Xa Inhibitors - standards</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Obesity</subject><subject>Obesity, Morbid - complications</subject><subject>Obesity, Morbid - metabolism</subject><subject>Obesity, Morbid - surgery</subject><subject>Practice Guidelines as Topic</subject><subject>Rivaroxaban</subject><subject>Rivaroxaban - administration & dosage</subject><subject>Rivaroxaban - pharmacokinetics</subject><subject>Rivaroxaban - standards</subject><subject>Thromboprophylaxis</subject><subject>Thrombosis - drug therapy</subject><subject>Thrombosis - prevention & control</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EokvhHyCUI5eEsRM7yQUJVnxUqtSKwtka25PWIYmLnVTsvydhtxcunEbWPPOO_AxjrzkUHLh61xc49iO5QgCvC5AFcP6E7biUMq-5Ek_ZDgBE3pZVecZepNSvT2iles7ORKOAy0rtmLuYumGhyVLKQpddGUp-PmQ4uewjRo9z9Da7WeItxUMWpmy-o2w_-MlbHP5S13cYR7RhCLcreR1D5wfaor75B4zhNxqcXrJnHQ6JXp3qOfvx-dP3_df88urLxf7DZW4rVc65wZqkMUCSoGpKZ9C1aGRXE3LhrDAIrhZcdLVSUjZdRy0Qls4CmgYcL8_Z22PufQy_FkqzHn2yNAw4UViS5i20XFVKVStaHVEbQ0qROn0f_YjxoDnoza_u9dGv3vxqkHr1u469OW1YzNZ7HHoUugLvjwCt_3zwFHWyftPrfCQ7axf8_zb8G2BPun_SgVIfljitDjXXSWjQN9uNtxPzugTZtKL8A24eo_s</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Moore, Kenneth Todd, MS</creator><creator>Kröll, Dino, MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Influences of Obesity and Bariatric Surgery on the Clinical and Pharmacologic Profile of Rivaroxaban</title><author>Moore, Kenneth Todd, MS ; Kröll, Dino, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-ba7e5bb0e5e0483dbad9ab5f7ea12dc2ba0d7212f766558ffe90ea3dc0ab80d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Anticoagulants</topic><topic>Bariatric surgery</topic><topic>Bariatric Surgery - adverse effects</topic><topic>Bariatric Surgery - standards</topic><topic>Factor Xa Inhibitors - administration & dosage</topic><topic>Factor Xa Inhibitors - pharmacokinetics</topic><topic>Factor Xa Inhibitors - standards</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Obesity</topic><topic>Obesity, Morbid - complications</topic><topic>Obesity, Morbid - metabolism</topic><topic>Obesity, Morbid - surgery</topic><topic>Practice Guidelines as Topic</topic><topic>Rivaroxaban</topic><topic>Rivaroxaban - administration & dosage</topic><topic>Rivaroxaban - pharmacokinetics</topic><topic>Rivaroxaban - standards</topic><topic>Thromboprophylaxis</topic><topic>Thrombosis - drug therapy</topic><topic>Thrombosis - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moore, Kenneth Todd, MS</creatorcontrib><creatorcontrib>Kröll, Dino, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moore, Kenneth Todd, MS</au><au>Kröll, Dino, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influences of Obesity and Bariatric Surgery on the Clinical and Pharmacologic Profile of Rivaroxaban</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>130</volume><issue>9</issue><spage>1024</spage><epage>1032</epage><pages>1024-1032</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><abstract>Abstract The health implications of obesity are myriad and multifaceted. Physiologic changes associated with obesity can affect the absorption, distribution, metabolism, and excretion of administered drugs, thereby altering their pharmacologic profiles. In 2016, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis published recommendations regarding the use of direct oral anticoagulants (DOACs) in obese patients. This guidance provides uniform recommendations for all DOACs, yet data suggest that individual agents may be affected to different degrees by obesity. Moreover, there are no recommendations currently available to guide DOAC use in bariatric surgery patients, in whom anatomic and physiologic changes to the digestive system can influence drug pharmacokinetics. 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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Anticoagulants Bariatric surgery Bariatric Surgery - adverse effects Bariatric Surgery - standards Factor Xa Inhibitors - administration & dosage Factor Xa Inhibitors - pharmacokinetics Factor Xa Inhibitors - standards Humans Internal Medicine Obesity Obesity, Morbid - complications Obesity, Morbid - metabolism Obesity, Morbid - surgery Practice Guidelines as Topic Rivaroxaban Rivaroxaban - administration & dosage Rivaroxaban - pharmacokinetics Rivaroxaban - standards Thromboprophylaxis Thrombosis - drug therapy Thrombosis - prevention & control |
| title | Influences of Obesity and Bariatric Surgery on the Clinical and Pharmacologic Profile of Rivaroxaban |
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