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 : 2025-04-01 Epub 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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心房颤动和既往胃部手术患者体内直接口服抗凝剂的血浆变异性：试验性病例系列。

背景：目前还缺乏关于曾接受过胃部手术的房颤（AF）患者使用直接口服抗凝剂（DOAC）预防心肌栓塞的数据。我们报告了胃部手术患者 DOAC 浓度在个体间和个体内的差异，以确定潜在的治疗方案：方法：从地区性 EDDIE-AF 登记处选取既往接受过胃部手术的患者，接受 DOAC 治疗房颤作为中风二级预防，并接受峰透 DOAC 血浆检测。使用西门子Innovance®检测仪在开始使用DOAC后至少75-102小时检测DOAC水平：结果：共纳入了 8 名曾接受过胃部手术的患者（平均年龄 75 岁，50% 为女性）。总体而言，只有 20/36 次检测结果在范围之内（55.5%；阿哌沙班 75.0%；达比加群 0%；依度沙班 64.3%；利伐沙班 33.3%）。利伐沙班和达比加群未达到治疗峰-槽浓度。阿哌沙班和埃多沙班分别在4/6和3/7的病例中达到治疗水平，其余所有病例中均有轻微的目标外浓度：我们的数据支持胃手术后 DOAC 吸收的一致性变异，这表明只要 DOAC 优于华法林，实施 DOAC 血浆检测可能有助于确保达到治疗水平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.