Recommendations Released for Use of Direct Oral Anticoagulants in Obese Patients

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Researchers recommend appropriate standard dosing for patients with BMI greater than 40.
Researchers recommend appropriate standard dosing for patients with BMI greater than 40.

(HealthDay News) — Recommendations have been issued for the use of direct oral anticoagulants (DOACs) in obese patients; the guideline was published in the Journal of Thrombosis and Haemostasis.

Karlyn Martin, MD, from the University of North Carolina at Chapel Hill, and colleagues reviewed the literature and developed guidance for clinicians relating to the use of DOACs in obese patients.

The authors recommend appropriate standard dosing of DOACs in patients with a BMI up to 40 and weight of 120 kg for treatment and prevention of venous thromboembolism, and for prevention of ischemic stroke and systemic arterial embolism in nonvalvular atrial fibrillation. 

Due to limited clinical data for patients at the extreme of weight, use of DOACs is not recommended for patients with BMI greater than 40 or weight greater than 120 kg; pharmacokinetic/pharmacodynamic evidence suggests decreased drug exposure, reduced peak concentration, and shorter half-lives with increasing weight. 

A drug-specific peak and trough level should be checked if DOACs are used for patients with BMI greater than 40 or weight greater than 120 kg; continuation of DOAC seems reasonable if the level falls within the expected range.

"As for all cases, our statements may provide guidance but do not replace clinical judgment for the management of individual patients," the authors wrote.

Several authors disclosed financial ties to the pharmaceutical industry.

Reference

  1. 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. doi:10.1111/jth.13323.
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