The American journal of medicine | 2021
Thromboembolism, bleeding, and mortality incidence of direct oral anticoagulants versus warfarin post-bariatric surgery: A systematic review and meta-analysis.
Abstract
BACKGROUND\nThere is no randomized controlled trial comparing direct oral anticoagulants (DOACs) and warfarin following bariatric surgery to date. The mortality, thromboembolism, and bleeding risk of DOAC in comparison with warfarin following bariatric surgery remains unclear. We aimed to provide a clinical comparison between DOAC and warfarin for these three pre-specified outcomes.\n\n\nMETHODS\nA systematic literature search was performed on 11/10/2019 using Pubmed, Embase, clinicaltrial.gov, and Cochrane databases. Studies with adult patients who were on either warfarin or DOAC following bariatric surgery and reported the incidence of thromboembolism, bleeding or mortality were included. Pooled incidence for these pre-specified outcomes and its 95% confidence interval (CI) were calculated for each drug separately using the random-effects model, along with a non-adjusted p-value comparing the 2 subgroups.\n\n\nRESULTS\nEleven studies (805 patients) were included. Comparing DOACs to warfarin, the following pooled incidences were observed for mortality (DOAC: 3.0%; 95%CI 0.4%-18.6% versus warfarin: 1.5%; 95%CI 0.8%-2.9%; p-value comparing the 2 subgroups=0.38), thromboembolism (DOAC: 4.9%; 95%CI 1%-21.1% versus warfarin: 1.5%; 95%CI 0.8%-2.9%; p-value=0.18) and bleeding (DOAC: 3.9%; 95%CI 0.7%-18.2% versus warfarin: 11.3%; 95%CI 5.7%-21.4%; p-value=0.23).\n\n\nCONCLUSION\nThe results of our meta-analysis remain hypothesis-generating, providing rationale for future randomized controlled trial design or well-designed comparative observational studies. Currently, it does not support the change in the current recommendation from warfarin to DOAC following bariatric surgery.