{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T15:56:30Z","timestamp":1773417390844,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2012,1,12]],"date-time":"2012-01-12T00:00:00Z","timestamp":1326326400000},"content-version":"vor","delay-in-days":1137,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2008,12]]},"abstract":"<jats:p>Nutritional deficiencies due to malabsorption occur after major gastric resection, and drugs that are primarily absorbed in the stomach or duodenum also are likely to exhibit decreased absorption. However, we performed a MEDLINE search (1960\u20132007) and found no evidence in the literature regarding the specific effects of warfarin absorption after total gastrectomy with Roux\u2010en\u2010Y gastric bypass procedure. We describe a 71\u2010year\u2010old woman receiving warfarin therapy for chronic atrial fibrillation who underwent a completion gastrectomy and Roux\u2010en\u2010Y esophagojejunostomy for an invasive adenocarcinoma of her gastric remnant. Before surgery, her international normalized ratio (INR) had been stable in her target range of 2\u20133 with warfarin 5\u20136 mg\/day. At the time of her admission for the surgery, however, her INR was subtherapeutic at 1.73; warfarin was discontinued, and heparin and, subsequently, enoxaparin were used throughout her admission. After the surgery, the patient was discharged to a skilled nursing facility to continue bridge therapy with enoxaparin while warfarin was restarted and adjusted to a therapeutic INR of 2\u20133. Three months after discharge, the patient was hospitalized again for shortness of breath and was found to have an INR of 1.30 on admission, despite good compliance with her drugs. During this admission, the patient demonstrated resistance to warfarin therapy, requiring doses up to 20 mg\/day to reach a therapeutic INR. To our knowledge, this is the first case report to demonstrate that patients undergoing a complete gastric resection followed by a Roux\u2010en\u2010Y gastric bypass procedure may display warfarin resistance. Close monitoring and dosage adjustment may be necessary to maintain therapeutic anticoagulation in these patients.<\/jats:p>","DOI":"10.1592\/phco.28.12.1537","type":"journal-article","created":{"date-parts":[[2008,11,24]],"date-time":"2008-11-24T08:04:42Z","timestamp":1227513882000},"page":"1537-1541","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Warfarin Resistance After Total Gastrectomy and Roux\u2010en\u2010Y Esophagojejunostomy"],"prefix":"10.1002","volume":"28","author":[{"given":"Diana M.","family":"Sobieraj","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orlando C.","family":"Kirton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,1,12]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01421.x"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp060033"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)45689-6"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-198916040-00003"},{"key":"e_1_2_1_6_2","first-page":"95","article-title":"Absorption of warfarin from the stomach and small intestine","volume":"9","author":"Pyorala K","year":"1971","journal-title":"Scand J Gastroenterol Suppl"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.1998.tb03129.x"},{"key":"e_1_2_1_8_2","first-page":"99","article-title":"Warfarin absorption after massive small\u2010bowel resection","volume":"80","author":"Lutomski DM","year":"1985","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200443140-00001"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.1994.tb00826.x"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.3_suppl.204S"},{"key":"e_1_2_1_12_2","unstructured":"Nestl\u00e9 Nutrition.Vivonex RTF product detail April 2008. 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