How to proceed with long-term anticoagulation in patient after total gastrectomy and atrial fibrillation?
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To the Editor:
Long-term oral anticoagulation is recommended to prevent stroke and systemic embolism in patients with atrial fibrillation (AF) . Non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as the preferred choice in these patients .However, published data has recently demonstrated that dabigatran-PPI interaction significantly reduces dabigatran plasma levels [3, 4], most probably mediated through the effect on gastric pH . This implies that dabigatran would not be highly soluble also among post-total gastrectomy patients, as they have no gastric acid secretion. Nevertheless, there are no data about post-total gastrectomy patients with non-valvular atrial fibrillation treated with dabigatran.
A 68-year-old post-total gastrectomy patient due to the diffuse large B cell lymphoma, in complete remission, and with permanent AF, was admitted to the Department of Internal Medicine I. He had been taking 150 mg of dabigatran etexilatetherapy twice daily before...
The authors would like to thank Mr. Paul McCullough for proofreading.
This study was supported by project APVV (Slovak Research and Development Agency) 16-0020 and by research project UK/386/2018 of Comenius University in Bratislava.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval and inform consent
This research was done according to ethical standards and was approved by the local ethical committee (Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava). The patient agreed to participate in the research and signed an informed consent for study participation.
- 2.Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Collins R, Camm AJ, Heidbüchel H, ESC Scientific Document Group (2018) The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 39:1330–1393CrossRefGoogle Scholar
- 3.Bolek T, Samoš M, Stančiaková L, Ivanková J, Škorňová I, Staško J, Galajda P, Kubisz P, Mokáň M (2017) The Impact of proton pump inhibition on dabigatran levels in patients with atrial fibrillation. Am J Ther. https://doi.org/10.1097/MJT.0000000000000599
- 4.Kuwayama T, Osanai H, Ajioka M, Tokuda K, Ohashi H, Tobe A, Yoshida T, Masutomi T, Kambara T, Inoue Y, Nakashima Y, Asano H, Sakai K (2017) Influence of proton pump inhibitors on blood dabigatran concentrations in Japanese patients with non-valvular atrial fibrillation. J Arrhythm 33:619–623CrossRefGoogle Scholar
- 11.Reilly PA, Lehr T, Haertter S et al (2014) RE-LY investigators. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (randomized evaluation of long-term anticoagulation therapy). J Am Coll Cardiol 63:321–328CrossRefGoogle Scholar