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Subtherapeutic anticoagulation with dabigatran following Roux-en-Y gastric bypass surgery.

ABSTRACT: We report a 66-year-old male with a history of Roux-en-Y gastric bypass surgery who began dabigatran for new onset atrial fibrillation. After 5 weeks of therapy, his transesophageal echocardiogram prior to electrocardioversion showed severe spontaneous echo contrast. Cardioversion was postponed and anticoagulant therapy was continued. The following day, he suffered a thromboembolic stroke. Concern arose that postoperative malabsorption could have resulted in subtherapeutic anticoagulation. This notion was strengthened by a second patient who had subtherapeutic serum levels despite maximal dosing. To the best of our knowledge, we are the first to report impaired absorption of dabigatran following Roux-en-Y gastric bypass surgery. .

SUBMITTER: Lee D

PROVIDER: S-EPMC6281513 | biostudies-other | 2013 Jul

REPOSITORIES: biostudies-other

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Subtherapeutic anticoagulation with dabigatran following Roux-en-Y gastric bypass surgery.

Lee Daniel D DeFilipp Zachariah Z Judson Kenneth K Kennedy Margaret M

Journal of cardiology cases 20130429 1

We report a 66-year-old male with a history of Roux-en-Y gastric bypass surgery who began dabigatran for new onset atrial fibrillation. After 5 weeks of therapy, his transesophageal echocardiogram prior to electrocardioversion showed severe spontaneous echo contrast. Cardioversion was postponed and anticoagulant therapy was continued. The following day, he suffered a thromboembolic stroke. Concern arose that postoperative malabsorption could have resulted in subtherapeutic anticoagulation. This ...[more]

PMID: 30546740

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