Key result
Dabigatran linked to the lowest rate of therapeutic drug levels in extreme-weight patients vs. other DOACs.
Why the study?
Due to limited clinical data on DOAC use in extremely abnormal weight ranges, optimal pharmacotherapy in this population remains controversial.
Does the type of DOAC affect the achievement of therapeutic drug concentrations in patients with extreme body weight?
Observational (n=38)
No
Does the type of DOAC affect the achievement of therapeutic drug concentrations in patients with extreme body weight?
p-value: p=0.015
Patients with extreme body weight may not reliably achieve therapeutic DOAC concentrations, particularly when treated with dabigatran, suggesting a potential role for therapeutic drug monitoring in this population.
Subtherapeutic levels may occur more often with dabigatran in extreme body weight; leaves open optimal DOAC selection and monitoring role.
, or body weight > 120 kg for obese subjects, and <50 kg for underweight subjects. Although low or high body weight is not a contraindication to DOACs therapy, it can significantly affect the safety and effectiveness of treatment. Due to the limited amount of clinical data on the use of DOACs in extremely abnormal weight ranges, optimal pharmacotherapy in this group of patients is a matter of controversy. The objective of this study was to evaluate the pharmacokinetics of DOAC properties in patients with abnormal body weight beyond the established cut-off points in the phase III studies for rivaroxaban, apixaban, and dabigatran. In total, 38 patients took DOACs for at least 12 months for non-valvular atrial fibrillation in 2019-2021. Blood samples were collected before the planned intake of the drug and 4 h after its administration. The determined concentrations of DOACs were statistically analyzed in relation to body weight, age, and eGFR (estimated Glomerular Filtration Rate). Among subjects taking apixaban, rivaroxaban, and dabigatran, the smallest representation of patients who achieved therapeutic concentrations were those treated with dabigatran. The population of people with abnormal body weight is a potential risk group of patients, in which some of them do not reach the therapeutic range of DOACs.
No takes yet. Share an insight, caveat, or question.
Wołowiec et al. (2023) conducted an observational in Non-valvular atrial fibrillation (NVAF) in patients with extreme body weight (n=38). Direct oral anticoagulants (apixaban, rivaroxaban, dabigatran) was evaluated on Achievement of therapeutic DOAC concentration 4 hours after administration (p=0.015). In patients with extremely abnormal body weight, dabigatran was associated with the lowest rate of achieving therapeutic concentrations compared to apixaban and rivaroxaban.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: