Key result
Apixaban and rivaroxaban appear to have the most favorable safety and efficacy profiles for patients at extremes of body weight, whereas edoxaban and dabigatran should be avoided.
Why the study?
The selection and optimal dosing of DOACs in low- and high-body-weight patients has not yet been fully elucidated by clinical trials.
What is the optimal selection and dosing of DOACs for VTE treatment and cardioembolic stroke prevention in patients at extremes of body weight?
What is the optimal selection and dosing of DOACs for VTE treatment and cardioembolic stroke prevention in patients at extremes of body weight?
For patients at extremes of body weight requiring anticoagulation, apixaban and rivaroxaban are the preferred DOACs based on current evidence, while edoxaban and dabigatran should be avoided.
May support preferring apixaban or rivaroxaban at weight extremes; leaves open prospective trial confirmation.
PURPOSE: To review the literature on treatment of venous thromboembolism (VTE) and prevention of cardioembolic stroke with direct-acting oral anticoagulants (DOACs) in low- and high-body-weight patients and to make recommendations regarding agent selection and dosing in these patient populations. SUMMARY: The selection and optimal dosing of DOACs in low- and high-body-weight patients has not yet been fully elucidated by clinical trials; however, evidence suggests that issues of both safety and efficacy in patients at the extremes of body weight may warrant careful consideration when selecting a DOAC for such patients. This review provides a thorough discussion of the use of DOACs in the treatment of VTE and prevention of cardioembolic stroke in patients at the extremes of body weight and provides guidance regarding agent selection. CONCLUSION: While the published evidence on use of DOACs in patients at extremes of body weight is sparse, apixaban and rivaroxaban appear to have the most favorable safety and efficacy profiles. Edoxaban and dabigatran should be avoided.
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Covert et al. (2020) conducted a review in Venous thromboembolism and cardioembolic stroke. Direct-acting oral anticoagulants (DOACs) was evaluated. Apixaban and rivaroxaban appear to have the most favorable safety and efficacy profiles for patients at extremes of body weight, whereas edoxaban and dabigatran should be avoided.
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