Anticoagulation approach in morbid obesity: a comprehensive review on venous thromboembolism management

Figures

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  FIGURE 1. The relationship between obesity and venous thromboembolism. Adipocytes from obese individuals induce a low-grade inflammatory process by secreting pro-inflammatory cytokines. Additionally, the activated macrophages in adipose tissue, together with the pro-inflammatory cytokines, stimulate the expression of tissue factor, Factor VIII, and von Willebrand factor, promoting a pro-coagulable state. The altered adipose tissue also secretes elevated levels of plasminogen activator inhibitor-1, leading to impaired fibrinolysis. Moreover, obesity is associated with low levels of anti-inflammatory adipokines, such as adiponectin, which results in platelet activation (Created with BioRender.com).

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  FIGURE 2. Summary of key aspects of warfarin use in morbidly obese patients with VTE. VKA, vitamin K antagonist; INR, international normalized ratio (Created with BioRender.com).

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  FIGURE 3. Summary of key aspects of UFH use in morbidly obese patients with VTE. aPTT, activated partial thromboplastin time; UFH, unfractionated heparin (Created with BioRender.com).

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  FIGURE 4. Summary of key aspects of enoxaparin use in morbidly obese patients with VTE. LMWHs, low-molecular-weight heparins; VTE, venous thromboembolism; anti-Xa, anti-factor Xa (Created with BioRender.com).

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  FIGURE 5. Summary of key aspects of DOACs use in morbidly obese patients with VTE. DOACs, direct oral anticoagulants; VKAs, vitamin K antagonists; VTE, venous thromboembolism (Created with BioRender.com).

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  FIGURE 6. Summary of key aspects in special morbidly obese patients populations with VTE. VTE, venous thromboembolism; CKD, chronic kidney disease; CG, Cockcroft-Gault; CrCl, creatinine clearance; MDRD, Modification of the Diet in Renal Disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; BSA, body surface area; GFR, glomerular filtration rate; LMWH, low-molecular-weight heparin; DOACs, direct oral anticoagulants; INR, international normalized ratio (Created with BioRender.com).

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  FIGURE 7. Anticoagulation strategies suitable for the prophylaxis or treatment of venous thromboembolism in patients with a weight ≥120 kg or a BMI ≥40 kg/m2. INR, international normalized ratio; UFH, unfractionated heparin; AjBW, adjusted body weight; aPTT, activated partial thromboplastin time; anti-Xa, anti-factor Xa; DOACs, direct oral anticoagulants; VKA, vitamin K antagonists; CG, Cockcroft-Gault; MDRD, Modification of the Diet in Renal Disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration (Created with BioRender.com).