Our patient is a 48-year-old male known case of atrial fibrillation for 15 years, adherent to his medications, which are apixaban and beta-blocker. He has a history of sleeve gastrectomy two years ago and thereafter, developed a pulmonary embolism. There are studies that revealed that bariatric surgeries had an effect on some medications, especially in absorption. Most of the Direct oral anticoagulants (DOACs) are absorbed in the stomach and proximal intestines. This study demonstrates the possible relation between sleeve gastrectomy and reduced apixaban drug absorption, which can result in a risk of pulmonary embolism and deep vein thrombosis (DVT).
Keywords: Sleeve gastrectomy, atrial fibrillation, embolism, apixaban