No randomized controlled trials have examined the safety and efficacy of DOAC in obese patients
.
Background:
According to the Health Canada, obesity is defined by BMI 30 kg/m2.
Patients with class 1 (BMI 30.0-34.9) and class 2 (BMI 35.0-39.9)
• Studies in orthopedic surgery:
in a study that compared clinical outcomes in
patients undergoing total hip and knee arthroplasty
NO significant difference between the efficacy and safety of dabigatran and enoxaparin in patients with BMI above 30 were noted.
Another study found no association between BMI and risk of VTE recurrence or bleeding events in rivaroxaban-treated patients.
.Studies in venous thromboembolism:
1_in a systematic review and meta-analysis of patients with VTE treated with apixaban, dabigatran, and
rivaroxaban, anticoagulant efficacy was similar in patients >100 kg and <100kg.
2_ Another study found no association between BMI and risk of VTE recurrence or bleeding events in rivaroxaban-treated patients.
Studies in atrial fibrillation
A systematic review suggest that, among atrial fibrillation patients,
apixaban, dabigatran, rivaroxaban and edoxaban are equivalent to vitamin K antagonists in terms of efficacy and safety in obese patients.
• Extreme obesity: BMI >40 or weight >120 kg
Data and clinical experience of the use of DOACs in patients with a BMI >40 or weight >120 kg remain limited and advising for against the use of DOACs in such patients for any given scenario.
• Conclusions:
1_If DOACs are to be used in patients with a BMI>40 or >120 kg, patients should be informed of the limitations of the available information and potential risk of underdosing
2_There is no data on
best strategy for performing dose adjustments in obese patients..
References:
_ walla SR, et al. Relation of risk of stroke in patients with atrial fibrillation to body mass index.
_Boriani G, et al. Relationship between body mass index and outcomes in patients with atrial fibrillation treated with edoxaban or warfarin in the ENGAGE AF-TIM14:
_treatment of venous thromboembolism with rivaroxaban in relation to body Weight. A sub-analysis of the EINSTEIN DVT/PE studies. Thromb Haemost.
_Effective with a favourable safety profile in normal and overweight patient undergoing major orthopaedic surgery: a pooled analysis. Thromb Res.
2012;130(5):818-20.
_
The Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. .
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