Use of Oral Anticoagulants in Obese Patients - Abstract
The prevalence of obesity is increasing worldwide, and obesity is a known risk factor
for venous thromboembolism (VTE) and the development of atrial fibrillation. 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 for many patients. Obese patients are underrepresented in the majority of the pharmacologic and clinical trials for these medications, leaving uncertainty regarding the safety and efficacy of DOACs in this patient population. The adequacy of their fixed dosing regimens in patients with a body mass index (BMI) of 40 kg/m2 or greater, or a body weight of more than 120 kg remains in question, leading to concerns of under dosing, with resultant increased risk of thromboembolic events. Herein we review the available literature on the use of warfarin and DOACs in obese patients for the treatment of acute VTE and prevention of stroke and systemic embolization in atrial fibrillation.