RESUMO
We report a 66-year-old male with a history of Roux-en-Y gastric bypass surgery who began dabigatran for new onset atrial fibrillation. After 5 weeks of therapy, his transesophageal echocardiogram prior to electrocardioversion showed severe spontaneous echo contrast. Cardioversion was postponed and anticoagulant therapy was continued. The following day, he suffered a thromboembolic stroke. Concern arose that postoperative malabsorption could have resulted in subtherapeutic anticoagulation. This notion was strengthened by a second patient who had subtherapeutic serum levels despite maximal dosing. To the best of our knowledge, we are the first to report impaired absorption of dabigatran following Roux-en-Y gastric bypass surgery.
RESUMO
Acute coronary syndrome is a major public health problem. It is a leading cause of morbidity and mortality in patients with cardiovascular disease. Despite multiple guidelines, the standard medical therapies are not optimally utilized for prevention of adverse events in this population. In this article, we show that, on an institutional basis, improved compliance with the use of standard preventive medical therapies can decrease adverse outcomes in this patient population. These findings can provide further impetus to practice evidence-based therapies in a cost-effective manner, which may have very important clinical, economic, and health policy implications in this current environment.