College of Pharmacy
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HelixTalk Episode #109 - Clinical Controversy: Can Obese Patients Take DOACs for Acute VTE?
Date posted: February 25, 2020, 6:00 am
In this episode, we review the pros, cons, and literature regarding the use of DOACs versus warfarin in obese patients with venous thromboembolism.
- The 2016 Scientific and Standardization Subcommittee of the International Society on Thrombosis and Haemostasis (SSC ISTH) guidelines recommend against DOACs in patients with a BMI > 40 kg/m2 or body weight > 120 kg. This recommendation is made strictly on the basis of a lack of clinical data among this patient population.
- Rivaroxaban and apixaban are the two most studied DOACs among obese patients with venous thromboembolism (VTE). Both drugs appear to have small or no pharmacokinetic/pharmacodynamic changes among obese patients.
- The best available clinical data does not suggest worse outcomes among obese patients treated with DOACs instead of warfarin for VTE; however, the quality of this data is not sufficient to completely validate these efficacy and safety findings.
- As with non-obese patients, clinical decision making is of paramount importance when selecting an anticoagulant for obese patients with VTE. Patient-specific factors should be heavily weighted when selecting between a DOAC or warfarin.
- Martin K, Beyer-Westendorf J, Davidson BL, Huisman MV, Sandset PM, Moll S. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2016;14(6):1308–1313. doi:10.1111/jth.13323
- Di Minno MN, Lupoli R, Di Minno A, et al. Effect of body weight on efficacy and safety of direct oral anticoagulants in the treatment of patients with acute venous thromboembolism: a meta-analysis of randomized controlled trials. Ann Med. 2015 Feb;47(1):61-8. doi: 10.3109/07853890.2014.982064.
- Kido K, Lee JC, Hellwig T, et al. Use of Direct Oral Anticoagulants in Morbidly Obese Patients. Pharmacotherapy. 2020 Jan;40(1):72-83. doi: 10.1002/phar.2353.
- Coons JC, Albert L, Bejjani A, et al. Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism. Pharmacotherapy. 2020 Jan 22. doi: 10.1002/phar.2369.