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Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy

Direct oral anticoagulants (DOACs) are safe and effective in cancer patients treated for venous thromboembolism (VTE) or atrial fibrillation (AF). Gastrectomy is the treatment of choice in patients with localized upper gastrointestinal cancer. DOACs are absorbed in the upper gastrointestinal tract,...

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Autores principales: Puhr, Hannah C., Ilhan-Mutlu, Aysegül, Preusser, Matthias, Quehenberger, Peter, Kyrle, Paul A., Eichinger, Sabine, Eischer, Lisbeth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951361/
https://www.ncbi.nlm.nih.gov/pubmed/35336036
http://dx.doi.org/10.3390/pharmaceutics14030662
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author Puhr, Hannah C.
Ilhan-Mutlu, Aysegül
Preusser, Matthias
Quehenberger, Peter
Kyrle, Paul A.
Eichinger, Sabine
Eischer, Lisbeth
author_facet Puhr, Hannah C.
Ilhan-Mutlu, Aysegül
Preusser, Matthias
Quehenberger, Peter
Kyrle, Paul A.
Eichinger, Sabine
Eischer, Lisbeth
author_sort Puhr, Hannah C.
collection PubMed
description Direct oral anticoagulants (DOACs) are safe and effective in cancer patients treated for venous thromboembolism (VTE) or atrial fibrillation (AF). Gastrectomy is the treatment of choice in patients with localized upper gastrointestinal cancer. DOACs are absorbed in the upper gastrointestinal tract, but to what extent is unclear. In a retrospective analysis, hospital data were searched for adult patients who underwent gastrectomy for gastroesophageal or pancreatic cancer, and DOAC therapy for VTE or AF after gastrectomy. DOAC blood levels were determined by chromogenic assays before and after administration, and thromboembolic and bleeding complications were recorded. Eleven patients (median age 76 years) received a factor Xa inhibitor (FXaI; apixaban (3), edoxaban (3), rivaroxaban (4)) or the factor IIa inhibitor dabigatran (1) for VTE (7) or AF (4) after gastrectomy. Eight patients on FXaI had anti-Xa (aXa) trough levels within the expected range (ER). In all of them, aXa levels increased upon DOAC administration. Two patients on 30 mg edoxaban had low aXa trough levels. Administration of 20 mg of rivaroxaban resulted in trough levels in the ER in one of them. None of the FXaI patients had thromboembolism, while two experienced bleeding (arterial puncture site, gastrointestinal). One dabigatran AF patient with trough and peak concentrations below the ER had strokes during 110 mg and 150 mg dabigatran administration. While on apixaban, aXa levels were in the ER, and no clinical complications occurred. DOACs, particularly FXaI, were adequately absorbed in cancer patients after gastrectomy. Our observation of recurrent thromboembolic events in a patient treated with dabigatran warrants cautious use in this specific patient population.
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spelling pubmed-89513612022-03-26 Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy Puhr, Hannah C. Ilhan-Mutlu, Aysegül Preusser, Matthias Quehenberger, Peter Kyrle, Paul A. Eichinger, Sabine Eischer, Lisbeth Pharmaceutics Article Direct oral anticoagulants (DOACs) are safe and effective in cancer patients treated for venous thromboembolism (VTE) or atrial fibrillation (AF). Gastrectomy is the treatment of choice in patients with localized upper gastrointestinal cancer. DOACs are absorbed in the upper gastrointestinal tract, but to what extent is unclear. In a retrospective analysis, hospital data were searched for adult patients who underwent gastrectomy for gastroesophageal or pancreatic cancer, and DOAC therapy for VTE or AF after gastrectomy. DOAC blood levels were determined by chromogenic assays before and after administration, and thromboembolic and bleeding complications were recorded. Eleven patients (median age 76 years) received a factor Xa inhibitor (FXaI; apixaban (3), edoxaban (3), rivaroxaban (4)) or the factor IIa inhibitor dabigatran (1) for VTE (7) or AF (4) after gastrectomy. Eight patients on FXaI had anti-Xa (aXa) trough levels within the expected range (ER). In all of them, aXa levels increased upon DOAC administration. Two patients on 30 mg edoxaban had low aXa trough levels. Administration of 20 mg of rivaroxaban resulted in trough levels in the ER in one of them. None of the FXaI patients had thromboembolism, while two experienced bleeding (arterial puncture site, gastrointestinal). One dabigatran AF patient with trough and peak concentrations below the ER had strokes during 110 mg and 150 mg dabigatran administration. While on apixaban, aXa levels were in the ER, and no clinical complications occurred. DOACs, particularly FXaI, were adequately absorbed in cancer patients after gastrectomy. Our observation of recurrent thromboembolic events in a patient treated with dabigatran warrants cautious use in this specific patient population. MDPI 2022-03-17 /pmc/articles/PMC8951361/ /pubmed/35336036 http://dx.doi.org/10.3390/pharmaceutics14030662 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Puhr, Hannah C.
Ilhan-Mutlu, Aysegül
Preusser, Matthias
Quehenberger, Peter
Kyrle, Paul A.
Eichinger, Sabine
Eischer, Lisbeth
Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy
title Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy
title_full Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy
title_fullStr Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy
title_full_unstemmed Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy
title_short Absorption of Direct Oral Anticoagulants in Cancer Patients after Gastrectomy
title_sort absorption of direct oral anticoagulants in cancer patients after gastrectomy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951361/
https://www.ncbi.nlm.nih.gov/pubmed/35336036
http://dx.doi.org/10.3390/pharmaceutics14030662
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