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However, these surgeries, whether primarily restrictive or malabsorptive, raise questions about the pharmacology of oral drugs. Among widely used drugs, anticoagulants are the referent therapy to treat some cardiovascular diseases such as atrial fibrillation and venous thromboembolism. How bariatric surgery may impact pharmacological properties of oral anticoagulants, and more specifically, direct oral anticoagulants (DOACs) are difficult to anticipate. In this review, we describe available data concerning the potential impact of bariatric surgery on the pharmacology of oral anticoagulants. The vitamin K antagonists (VKAs) requirements for the same international normalized ratio target are reduced after bariatric surgery. Limited data available for dabigatran 150\u00a0mg twice daily indicate a risk of insufficient efficacy in atrial fibrillation after gastric bypass due to probable impaired absorption. Data for rivaroxaban at the prophylactic dose of 10\u00a0mg per day suggest no impact of bariatric surgery from 3\u00a0days to 8\u00a0months post\u2010surgery. However, no conclusive data are available for other anticoagulants or the use of DOACs at therapeutic doses. To date, DOACs are not recommended in patients who have undergone bariatric surgery, because of limited available data. Pending new studies to confirm the predictable pharmacokinetics and safety of DOACs in this population, especially at therapeutic doses, VKAs remain the first option for chronic anticoagulation.<\/jats:p>","DOI":"10.1111\/fcp.12587","type":"journal-article","created":{"date-parts":[[2020,7,4]],"date-time":"2020-07-04T04:10:33Z","timestamp":1593835833000},"page":"53-61","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Impact of bariatric surgery on oral anticoagulants pharmacology, and consequences for clinical practice: a narrative review"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0697-4370","authenticated-orcid":false,"given":"Cyril","family":"Leven","sequence":"first","affiliation":[{"name":"D\u00e9partement de Biochimie et Pharmaco\u2010toxicologie H\u00f4pital de la Cavale Blanche CHU Brest Bd Tanguy Prigent Brest Cedex F\u201029609 France"},{"name":"Universit\u00e9 de Bretagne Occidentale Brest EA3878 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9ment","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Bretagne Occidentale Brest EA3878 France"},{"name":"D\u00e9partement de M\u00e9decine Interne M\u00e9decine vasculaire et pneumologie CHU Brest Bd Tanguy Prigent Brest Cedex F\u201029609 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Roche","sequence":"additional","affiliation":[{"name":"Service de chirurgie visc\u00e9rale CHU Brest Bd Tanguy Prigent Brest Cedex F\u201029609 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Couturaud","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Bretagne Occidentale Brest EA3878 France"},{"name":"D\u00e9partement de M\u00e9decine Interne M\u00e9decine vasculaire et pneumologie CHU Brest Bd Tanguy Prigent Brest Cedex F\u201029609 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Thereaux","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Bretagne Occidentale Brest EA3878 France"},{"name":"Service de chirurgie visc\u00e9rale CHU Brest Bd Tanguy Prigent Brest Cedex F\u201029609 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karine","family":"Lacut","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Bretagne Occidentale Brest EA3878 France"},{"name":"D\u00e9partement de M\u00e9decine Interne M\u00e9decine vasculaire et pneumologie CHU Brest Bd Tanguy Prigent Brest Cedex F\u201029609 France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60813-1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckl073"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.3060"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.16.1523"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10999"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000972"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/17425255.2017.1290796"},{"key":"e_1_2_8_9_1","unstructured":"Bristol\u2010Myers Squibb Company.Coumadin (warfarin). 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