Abstract
In clinical practice, direct oral anticoagulants (DOACs) are increasingly used for
venous thromboembolism treatment and prevention. A substantial proportion of patients
with venous thromboembolism are also obese. International guidance published in 2016
stated that DOACs could be used in standard doses in patients with obesity up to a
body mass index [BMI] of 40 kg/m2, but should not be used in those with severe obesity (BMI > 40 kg/m2) owing to limited supporting data at the time. Although updated guidance in 2021
removed this limitation, some healthcare providers still avoid DOACs even in patients
with lower levels of obesity. Furthermore, there are still evidence gaps regarding
treatment of severe obesity, the role of peak and trough DOAC levels in these patients,
use of DOACs after bariatric surgery, and appropriateness of DOAC dose reduction in
the setting of secondary venous thromboembolism prevention. This document describes
proceedings and outcomes of a multidisciplinary panel convened to review these and
other key issues regarding DOAC use for treatment or prevention of venous thromboembolism
in individuals with obesity.
Keywords
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Article info
Publication history
Accepted:
January 19,
2023
Received:
December 17,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Note: All authors participated in the writing of the manuscript and have seen and approved the submitted version. Further, each author has been involved in the conception and design of the study, or the analysis of the data.
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Copyright
© 2023 Published by Elsevier Inc.
