Anticoagulation After Bariatric Surgery: Beyond Warfarin
- 1Department of Internal Medicine Brown University
- 2Department of Medicine Brown University
- 3Division of Hospital Medicine, Department of Medicine Miriam Hospital, Brown University Health
Abstract
While Direct Oral Anticoagulants (DOACs) have proven noninferior or superior to Vitamin K Antagonists (VKAs/warfarin) in many contexts, questions remain around which agent to choose after bariatric surgery. Here we present the case of a 44-year-old woman with a complex medical history, including subtotal gastrectomy and Roux-en-Y gastric bypass, who presented with a panoply of symptoms including gross hematuria and International Normalized Ratio (INR) >12 on warfarin. After inflammatory processes were ruled out, she was diagnosed with numerous vitamin and mineral deficiencies, including vitamin K, vitamin C, and vitamin D. Warfarin was switched to apixaban. Peak apixaban levels were measured at goal, demonstrating therapeutic absorption of this drug even in the setting of chronic, severe malabsorption. This case demonstrates the importance of considering nutritional deficiencies as a unifying diagnosis and challenges the belief that DOACs should be avoided after bariatric surgery.
Related
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- Tirzepatide for Weight Recurrence After Metabolic and Bariatric Surgery: A Critical Review of Direct and Indirect Evidence with Emphasis on Sleeve Gastrectomy, Nutritional Safety, and Clinical Implications
- Glucagon-Like Peptide-1 Receptor Agonist Use Is Associated With Increased Peripheral Nerve Compression After Bariatric Surgery
- Comment on Campuzano-Donoso et al. Alcohol and Substance Use After Bariatric Surgery: Nutritional Risks and Clinical Implications in Long-Term Postoperative Care. Nutrients 2026, 18, 932
- Reply to Strømmen, M.; Skråstad, R.B. Comment on “Campuzano-Donoso et al. Alcohol and Substance Use After Bariatric Surgery: Nutritional Risks and Clinical Implications in Long-Term Postoperative Care. Nutrients 2026, 18, 932”
BibTeX
@article{walden2026anticoagulation,
title = {{Anticoagulation After Bariatric Surgery: Beyond Warfarin}},
author = {Daniel Walden and Emily Wang and Kwame Dapaah-Afriyie},
journal = {Journal of Brown hospital medicine},
year = {2026},
month = oct,
doi = {10.56305/001c.170194},
url = {https://europepmc.org/article/PMC/PMC13730615},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Anticoagulation After Bariatric Surgery: Beyond Warfarin
AU - Daniel Walden
AU - Emily Wang
AU - Kwame Dapaah-Afriyie
PY - 2026
DA - 2026/10/01
JO - Journal of Brown hospital medicine
DO - 10.56305/001c.170194
UR - https://europepmc.org/article/PMC/PMC13730615
AB - While Direct Oral Anticoagulants (DOACs) have proven noninferior or superior to Vitamin K Antagonists (VKAs/warfarin) in many contexts, questions remain around which agent to choose after bariatric surgery. Here we present the case of a 44-year-old woman with a complex medical history, including subtotal gastrectomy and Roux-en-Y gastric bypass, who presented with a panoply of symptoms including gross hematuria and International Normalized Ratio (INR) >12 on warfarin. After inflammatory processes were ruled out, she was diagnosed with numerous vitamin and mineral deficiencies, including vitamin K, vitamin C, and vitamin D. Warfarin was switched to apixaban. Peak apixaban levels were measured at goal, demonstrating therapeutic absorption of this drug even in the setting of chronic, severe malabsorption. This case demonstrates the importance of considering nutritional deficiencies as a unifying diagnosis and challenges the belief that DOACs should be avoided after bariatric surgery.
SN - 2994-5593
ER -