Why the study?
Obesity and bariatric surgery alter anticoagulant pharmacokinetics and pharmacodynamics, creating uncertainty regarding the best antithrombotic strategies, especially in the morbidly obese.
How should oral anticoagulants be managed in obese patients, considering altered pharmacokinetics and pharmacodynamics?
How should oral anticoagulants be managed in obese patients, considering altered pharmacokinetics and pharmacodynamics?
This article provides practical clinical guidance and a literature review on the complex management of oral anticoagulation in obese patients.
May inform individualized anticoagulation strategies in morbid obesity; leaves open optimal dosing until prospective trials provide definitive guidance.
Obesity has become a major threat to health worldwide. The prevalence of obesity is rapidly increasing, so much so that the World Health Organization has declared obesity as a global epidemic. Obesity is associated with multiple health problems, including venous thromboembolism and atrial fibrillation, both of which are treated with anticoagulation. However, obesity and treatments for obesity such as bariatric surgery can influence absorption, excretion, pharmacokinetics, and pharmacodynamics of various anticoagulants. This results in uncertainty regarding the best antithrombotic strategies in this population, particularly in the morbidly obese. In the recent years, several studies have attempted to investigate anticoagulation use in this population and provided more insight. Herein, we present 4 cases of anticoagulant use in the obese to illustrate the common challenges faced by clinicians and discuss our approach. Whenever possible, we provide a review of the literature and base our recommendations on the best available evidence.
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Wang et al. (2020) studied this question.