The use of anticoagulants in morbidly obese patients

Domienik‐Karłowicz, Justyna; Pruszczyk, Piotr

doi:10.5603/cj.a2015.0054

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…NOACs have short half-lives and if patients miss 2 doses they will be unprotected. A recent review has shown that morbid adiposity may reduce the efficacy of NOACs [19]. NOACs have fewer pharmacokinetic/-dynamic interactions than VKAs but they have important interactions with inhibitors of the P-glycoprotein transporter and with several drugs used in cardiology [15][16][17][20][21][22].…”

Section: Risks Of Oral Anticoagulationmentioning

confidence: 99%

Anti-thromboembolic strategies in atrial fibrillation

Cocco

Amiet

Jerie³

2016

Cardiol J.

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Section: Risks Of Oral Anticoagulationmentioning

confidence: 99%

Anti-thromboembolic strategies in atrial fibrillation

Cocco

Amiet

Jerie³

2016

Cardiol J.

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“…Prothrombin time is an assay evaluating the extrinsic pathway of coagulation. The international normalized ratio (INR) is used to standardize the prothrombin time and the optimal intensity of anticoagulant therapy corresponds to a target INR of 2.5 (range, 2.0 to 3.0) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Both prophylaxis and treatment of VTE and pulmonary embolism (PE) with anticoagulants are associated with significant risks of major and fatal hemorrhage. Both anticoagulant treatment and lifestyle changes should be individualized to prevent further complications [ 9 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Nutritional management of a patient with obesity and pulmonary embolism: a case report

Fonte

Fietchner

Manuelli

et al. 2016

Nutr J

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BackgroundThe aim of this case report is to discuss the issue of nutritional therapy in patients taking warfarin. Patients are often prescribed vitamin K free diets without nutritional counseling, leading to possible health consequences.Case presentationA 52-year-old woman with obesity and hypertension was prescribed a low calorie diet by her family doctor in an effort to promote weight loss. After a pulmonary embolism, she was placed on anticoagulant therapy and on hospital discharge she was prescribed a vitamin K free diet to avoid interactions. Given poor control of her anticoagulant therapy, she was referred to our Nutritional Unit outpatients’ service.ConclusionsThis case illustrates the importance of a thorough medical nutrition assessment in the management of patients with obesity and the need for a change in the dietary approach of nutritional therapy in the management of vitamin K anticoagulant therapy. In patients taking warfarin, evidence suggest that the aim of nutritional therapy should be to keep dietary intake of vitamin K constant.

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“…ey are also deemed safe for use as prophylaxis for venous thromboembolism (VTE) in patients undergoing knee or hip replacement surgery. ese newer agents have shown equal efficacy as low-molecular weight heparin (LMWH) and VKAs [6,7]. In addition, studies have shown no differences in efficacy to VKAs or LMWH in overweight and obese patients [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Drug exposures were found to be decreased along with reduced concentrations and shortened half-lives (time to steady state) in patients with BMI >40 kg/m 2 . Other smaller studies and case reports have demonstrated stable pharmacokinetics and pharmacodynamics in obese patients for both rivaroxaban and apixaban [7,19,20]. To date, there exists no strong evidence of clinical efficacy and safety in obese patients on therapeutic DOACs.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Direct-Acting Oral Anticoagulants (DOACs) in the Overweight and Obese

Doucette

Latif

Vakiti

et al. 2020

Advances in Hematology

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Obesity plays an essential role in the safety of pharmacologic drugs. There is paucity of data for direct oral anticoagulants (DOACs) in the obese, despite these agents becoming more widely used. The primary and secondary objectives of this study were to assess the safety and efficacy of DOACs in the overweight and obese populations when used for primary prophylaxis in the setting of non-valvular atrial fibrillation (NVAF) and for treatment of venous thromboembolisms (VTE). We conducted a retrospective cohort study in a large tertiary care center and obtained data through review of electronic health records. Among patients with NVAF and VTE on apixaban, there were no differences in rates of major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) in the overweight and obese populations when compared to normal weight and underweight individuals. The multivariate adjusted analysis for rivaroxaban found that the odds of CRNMB for patients with BMI <25 was 5.37 (95% CI 1.50–19.32) times higher than that of BMI ≥25. Moreover, patients on medications that had known interactions with DOACs had 6.40 times higher odds of CRNMB than patients without such interactions (95% CI 1.49–27.57), which was not accounted for by the effects of aspirin and plavix alone. Efficacy was similar between all weight groups, for both apixaban and rivaroxaban. These results support previous analyses preformed in the large phase III trials and confirm that apixaban and rivaroxaban are safe in the overweight and obese.

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The use of anticoagulants in morbidly obese patients

Abstract: (Cardiol J 2016; 23, 1: 12-16)

Cited by 10 publications

References 28 publications

Anti-thromboembolic strategies in atrial fibrillation

Anti-thromboembolic strategies in atrial fibrillation

Nutritional management of a patient with obesity and pulmonary embolism: a case report

Efficacy and Safety of Direct-Acting Oral Anticoagulants (DOACs) in the Overweight and Obese

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