warfarin and Weight-Loss

Bariatric surgery may alter the absorption, distribution, metabolism, or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited, and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of currently available data, it appears most prudent to use warfarin with international normalized ratio monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery.

Topics: Absorption, Physiological; Administration, Oral; Anticoagulants; Bariatric Surgery; Biological Availability; Drug Monitoring; Energy Intake; Humans; Vitamin K; Warfarin; Weight Loss

Topics: Anticoagulants; Atrial Appendage; Atrial Fibrillation; Catheter Ablation; Factor Xa Inhibitors; Humans; Warfarin; Weight Loss

Topics: Gastrectomy; Gastric Bypass; Humans; Laparoscopy; Obesity, Morbid; Treatment Outcome; Warfarin; Weight Loss

The aim of this case report is to discuss the issue of nutritional therapy in patients taking warfarin. Patients are often prescribed vitamin K free diets without nutritional counseling, leading to possible health consequences.. A 52-year-old woman with obesity and hypertension was prescribed a low calorie diet by her family doctor in an effort to promote weight loss. After a pulmonary embolism, she was placed on anticoagulant therapy and on hospital discharge she was prescribed a vitamin K free diet to avoid interactions. Given poor control of her anticoagulant therapy, she was referred to our Nutritional Unit outpatients' service.. This case illustrates the importance of a thorough medical nutrition assessment in the management of patients with obesity and the need for a change in the dietary approach of nutritional therapy in the management of vitamin K anticoagulant therapy. In patients taking warfarin, evidence suggest that the aim of nutritional therapy should be to keep dietary intake of vitamin K constant.

Topics: Anticoagulants; Caloric Restriction; Female; Humans; Hypertension; Middle Aged; Nutrition Assessment; Obesity; Pulmonary Embolism; Vitamin K; Warfarin; Weight Loss

This represents the fifth article in the series on yearly updates of hot topics in long term care.

Topics: Anti-Ulcer Agents; Anticoagulants; Atrial Fibrillation; Clopidogrel; Clostridioides difficile; Delirium; Diabetes Complications; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Female; Fractures, Bone; Geriatric Nursing; Humans; Male; Nursing Homes; Omeprazole; Osteoporosis; Peptic Ulcer; Platelet Aggregation Inhibitors; Pneumonia, Bacterial; Polypharmacy; Proton Pump Inhibitors; Risk Factors; Ticlopidine; Warfarin; Weight Loss

Topics: Adverse Drug Reaction Reporting Systems; Aged; Anemia, Hemolytic, Autoimmune; Anti-Infective Agents; Anticoagulants; Benzodiazepines; Caffeine; Canada; Ceftriaxone; Central Nervous System Stimulants; Child; Drug Interactions; Female; Humans; Ketolides; Middle Aged; Olanzapine; Peripheral Nervous System Diseases; Phytotherapy; Pulmonary Embolism; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Warfarin; Weight Loss