Key result
DOACs lack robust evidence in extreme obesity, favoring warfarin or drug-level monitoring.
Why the study?
Does the use of DOACs provide adequate clinical efficacy and safety compared to warfarin in extremely obese patients (BMI > 40 kg/m2 or > 120 kg)?
Does the use of DOACs provide adequate clinical efficacy and safety compared to warfarin in extremely obese patients (BMI > 40 kg/m2 or > 120 kg)?
Due to insufficient pharmacokinetic and clinical outcome data, caution is warranted when using DOACs in extremely obese patients, and warfarin or concentration monitoring is preferred.
Caution with unmonitored DOACs in extreme obesity persists; leaves open need for dedicated RCTs in BMI >40 kg/m².
Extreme obesity-also referred to as severe, grade III, or morbid obesity-is defined as a body mass index (BMI) > 40 kg/m 2 , and occurs in 7.7% of the adult US population. 1 This translates to nearly 20 million extremely obese adults living in the US. 2 Considering the prevalence of atrial fibrillation (AF), there may be at least 615 000 extremely obese adults with atrial fibrillation in the US. 3 As 67%-88% of AF patients
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Moll et al. (2018) conducted a review in Atrial fibrillation and venous thromboembolism in extremely obese adults. Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated. Robust clinical data supporting DOAC use in patients with extreme obesity are lacking, leading to a preference for warfarin or DOACs with therapeutic monitoring in this population.
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