The use of anticoagulants in morbidly obesity patients. Although by definition this.
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Graves KK Edholm K Johnson SA 2017 Use of Oral Anticoagulants in Obese Patients.
How i treat obese patients with oral anticoagulants pdf. Search for other works by this author on. However obesity and treatments for obesity such as bariatric surgery can influence absorption excretion pharmacokinetics and pharmacodynamics of various anticoagulants. While warfarin remains the most commonly prescribed oral anticoagulant worldwide direct oral anticoagulants DOACs offer fewer drug and dietary interactions and do not require routine lab monitoring making them enticing options.
There is paucity of data on their effectiveness in obese patients with venous thrombo-embolism VTE. Obesity is associated with multiple health problems including venous thromboembolism and atrial fibrillation both of which are treated with anticoagulation. Four DOACs are approved for clinical use in Canada.
The prevalence of obesity is increasing worldwide and obesity is a known risk factor for venous thromboembolism VTE and the development of atrial fibrillation. Tzu-Fei Wang Tzu-Fei Wang. How I treat obese patients with oral anticoagulants.
Consequently direct oral anticoagulants can be prescribed in a fixed-dose regimen without the need for routine laboratory monitoring thereby overcoming some of the main limitations of vitamin K antagonists. Obesity is associated with multiple health problems including venous thromboembolism and atrial fibrillation both of which are treated with anticoagulation. Therefore comparing the risk of stroke and major bleeding MB in a real-world population of NVAF patients with obesity and morbid obesity among oral anticoagulant OAC users is crucial.
Graves 30 N 1900 E Room 5R 218 Division. Clinical data for these patients 910. Of General Internal Medicine Salt Lake City UT USA Tel.
Direct oral anticoagulants DOAC use has gained significant traction given the lack of therapeutic monitoring and need for anticoagulant bridging. Studies on the use of direct oral anticoagulants DOACs in obese patients are limited. Anticoagulation in Patients With Obesity Wednesday July 1 2020 This month Tzu-Fei Wang MD and Marc Carrier MD MSc reviewed anticoagulation strategies for patients who are obese and therefore at risk of venous thromboembolism atrial fibrillation and cardiovascular diseases.
37 Full PDFs related to this paper. Four direct oral anticoagulants DOACs have been approved for the treatment of acute VTE 3-6 including the direct Factor Xa inhibitors rivaroxaban apixaban and edoxaban and the direct thrombin inhibitor dabigatran. Are safe in obese patients with calculated RRs with a 95 CI crossing 1 Fig.
The main concern for the fixed-dose use of direct oral anticoagulants in extremely obese patients is their activity profile given that pharmacokinetic studies have suggested lower peak and trough concentrations associated with higher bodyweight. Yet whether a one-size-fits-all regimen is applicable to patients with obesity or extreme bodyweight is a topic of debate. However obesity and treatments for obesity such as bariatric surgery can influence absorption excretion pharmacokinetics and pharmacodynamics of various anticoagulants.
In an observational cohort of higher-risk PE patients DOAC therapy in morbidly obese patients was not associated with an increased risk of recurrent VTE compared to warfarin anticoagulation therapy within 6 months of management of acute PE and these higher-risk patients had similar recovery of right ventricle function on DOAC therapy as those treated with warfarin even among morbidly obese patients. How I Treat in Brief. Obesity is a well-known risk factor for venous thromboembolism VTE however obese patients are under-represented in clinical trials 12.
Current guidelines advise against DOAC use in patients with a body weight more than 120 kg or body mass index higher than 40 kgm 2. Multiple large phase 3 prospective RCTs have demonstrated the efficacy and safety of DOACs in the treatment of VTE or AF and subanalyses of these studies have not shown compromised efficacy or safety in the obese population27 28 29 30 31 Two meta-analyses of these RCTs concluded that there were no differences in the efficacy and safety in DOACs compared with VKA in patients with high body weight32 33 In addition high-body-weight AF patients. Therefore the aim of this study was to evaluate the effectiveness and safety of DOACs versus warfarin for the treatment of acute venous thromboembolism VTE in obese patients.
Notably in one trial AMPLIFY the major bleeding rate for patients with a BMI of 35 kg m 2 receiving apixaban was significantly lower than that for obese patients receiving a VKA apixa-ban 06 versus VKA 35 RR 016 95 CI 004 070. Apixaban dabigatran edoxaban and rivaroxaban. A short summary of this paper.
To provide guidance about the management of direct oral anticoagulants DOACs in obese patients. In 2016 the International Society on Thrombosis and Haemostasis ISTH published guidelines advising caution when using direct oral anticoagulants DOACs in patients with morbid obesity due to limited clinical efficacy and safety data supporting their use in this patient population. Rii cellece i e ccess Corresponding author.
The primary outcome was the proportion of patients with peak plasma DOAC concentrations that fall below the median trough of published population median trough levels The study found that. Tion was determined 2-3 hours after oral administration in 38 ex-tremely obese patients on anticoagulation mostly for AF and VTE. The use of NOACs in patients with morbid obesity has not been as well-documented or established.
DIRECT ORAL ANTICOAGULANTS IN OBESE PATIENTS OBJECTIVE. Download Full PDF Package. 1 Division of Hematology Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH.
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