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Long-Term Outcomes of Bariatric Surgery in Patients on Chronic Anticoagulation

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Abstract

Background

Approximately 3% of patients undergoing metabolic and bariatric surgery (MBS) are receiving chronic anticoagulation therapy (CAT) prior to operation. The management of these patients is complex, as it involves balancing the potential risk of thrombosis against that of bleeding. Our primary objective is to assess the long-term bleeding risk in patients undergoing MBS. We also aim to observe the trends in anticoagulant dosing after MBS.

Methods

A single-center retrospective review of patients who underwent either primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with preoperative CAT between 2008 and 2022 was performed. Data on baseline demographics, indication for anticoagulation, type of CAT, and dosing were collected. Events of bleeding and the CAT at event were subsequently evaluated.

Results

A total of 132 patients (82 RYGB and 50 SG) initially on CAT were identified, with atrial fibrillation being the most common indication. Incidence of long-term bleeding was significantly higher in the RYGB group (18.3%) compared to the SG group (4%) (p = 0.017) over a total of 5.2 ± 3.8 years. Bleeding marginal ulcer (MU) was the most common cause of bleeding in the RYGB group (13.4%). 84.2% of all bleeding events occurred in patients on chronic Warfarin therapy.

Conclusion

Long-term CAT is associated with an increased risk of bleeding in RYGB patients, particularly MU bleeds. Patients on CAT seeking MBS should be counseled regarding this risk and potential implications. Direct-acting oral anticoagulants offer promise as an alternative to Warfarin in these patients; further research is necessary to better understand their safety.

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Data Availability

The data that support the findings of this study are available from the corresponding author, Omar M. Ghanem, upon reasonable request.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Kamal Abi Mosleh, Amanda Belluzzi, Marita Salame, Michael L. Kendrick, Travis J. McKenzie & Omar M. Ghanem

  2. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Barham K. Abu Dayyeh

Authors
  1. Kamal Abi Mosleh
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  2. Amanda Belluzzi
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Corresponding author

Correspondence to Omar M. Ghanem.

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Ethics Approval

This study was deemed exempt by the Institutional Review Board.

Informed Consent

For this type of study informed consent does not apply.

Conflict of Interest

Barham K. Abu Dayyeh has received consulting fees from Endogenex, Endo-TAGSS, Metamodix, and BFKW; consulting fee and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; speaker honorarium from Olympus, Johnson and Johnson; speaker honorarium and grant/research support from Medtronic, Endogastric solutions; and research support/grant from Apollo Endosurgery, and Spatz Medical.

All the other authors (Kamal Abi Mosleh, Amanda Belluzzi, Marita Salame, Michael L. Kendrick, Travis J. McKenzie and Omar M. Ghanem) have no conflicts of interest to disclose.

These disclosures have no effect on the content of the manuscript.

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Key Points

1. Incidence of long-term bleeding following gastric bypass was 18.3% over 6 years.

2. Bleeding marginal ulcer was the most common cause of long-term bleeding after bypass.

3. Warfarin therapy was most commonly associated with long-term bleeding after bypass.

4. Careful monitoring of INR is warranted but not sufficient to avoid bleeding risk.

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Abi Mosleh, K., Belluzzi, A., Salame, M. et al. Long-Term Outcomes of Bariatric Surgery in Patients on Chronic Anticoagulation. OBES SURG 33, 4007–4016 (2023). https://doi.org/10.1007/s11695-023-06910-x

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  • DOI: https://doi.org/10.1007/s11695-023-06910-x

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