Key result
Dabigatran administration in an obese patient (BMI 44.7) with atrial fibrillation resulted in subtherapeutic levels below the 25th percentile and an ischemic stroke.
Dabigatran may not achieve therapeutic levels in severely obese patients, potentially leading to inadequate thromboprophylaxis and ischemic stroke.
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Raises concern for subtherapeutic dabigatran in severe obesity with AF; leaves open optimal management pending further evidence.
Breuer et al. (2013) studied this question. Dabigatran administration in an obese patient (BMI 44.7) with atrial fibrillation resulted in subtherapeutic levels below the 25th percentile and an ischemic stroke.
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