Jared Netley1, Kris Howard2, William Wilson3. 1. Department of Pharmacy, Parkview Health, 11109 Parkview Plaza Drive, Fort Wayne, IN, 46845, USA. Jared.netley@parkview.com. 2. Department of Pharmacy, Parkview Health, 11109 Parkview Plaza Drive, Fort Wayne, IN, 46845, USA. 3. Department of Cardiology, Parkview Health, 11109 Parkview Plaza Drive, Fort Wayne, IN, 46845, USA.
Abstract
BACKGROUND: The International Society on Thrombosis and Haemostasis recommends avoiding the use of direct oral anticoagulants (DOACs) in patients with a body mass index (BMI) greater than 40 kg/m2 or weight greater than 120 kg. HYPOTHESIS: Higher BMI is associated with altered pharmacokinetics which may affect the safety and effectiveness for DOACs. METHODS: Data were collected on 3458 patients taking a DOAC prior to admission to a Midwestern health system between February 2013 and August 2016. Of these, 43 patients had a thrombotic event and 70 patients had an overt bleeding event. Patients were stratified among the following three BMI groups: BMI < 30 kg/m2, BMI 30-40 kg/m2, and BMI > 40 kg/m2. RESULTS: There was no statistically significant difference between BMI groups for thrombotic events (p = 0.598) or for overt bleeding events (p = 0.065). The BMI < 30 kg/m2 had the highest occurrence rate of bleeding events. It was observed that bleeding occurrence decreased as the BMI groups increased. The BMI > 40 kg/m2 group had the lowest risk of bleeding events, and was the only group to have a higher occurrence rate of thrombotic events compared to bleeding events. CONCLUSIONS: Among patients admitted to a single health system on DOAC therapy over a three-and-a-half-year period, obesity did not significantly correlate with thrombotic or overt bleeding complications. This study is limited as a single health system study with low overall event rates. A preliminary finding of this study showed a trend towards decreased bleeding frequency as BMI increased.
BACKGROUND: The International Society on Thrombosis and Haemostasis recommends avoiding the use of direct oral anticoagulants (DOACs) in patients with a body mass index (BMI) greater than 40 kg/m2 or weight greater than 120 kg. HYPOTHESIS: Higher BMI is associated with altered pharmacokinetics which may affect the safety and effectiveness for DOACs. METHODS: Data were collected on 3458 patients taking a DOAC prior to admission to a Midwestern health system between February 2013 and August 2016. Of these, 43 patients had a thrombotic event and 70 patients had an overt bleeding event. Patients were stratified among the following three BMI groups: BMI < 30 kg/m2, BMI 30-40 kg/m2, and BMI > 40 kg/m2. RESULTS: There was no statistically significant difference between BMI groups for thrombotic events (p = 0.598) or for overt bleeding events (p = 0.065). The BMI < 30 kg/m2 had the highest occurrence rate of bleeding events. It was observed that bleeding occurrence decreased as the BMI groups increased. The BMI > 40 kg/m2 group had the lowest risk of bleeding events, and was the only group to have a higher occurrence rate of thrombotic events compared to bleeding events. CONCLUSIONS: Among patients admitted to a single health system on DOAC therapy over a three-and-a-half-year period, obesity did not significantly correlate with thrombotic or overt bleeding complications. This study is limited as a single health system study with low overall event rates. A preliminary finding of this study showed a trend towards decreased bleeding frequency as BMI increased.
Entities:
Keywords:
Body mass index; Direct oral anticoagulants; Obesity; Pharmacology
Authors: Alison R Novak; Courtney Shakowski; Toby C Trujillo; Garth C Wright; Scott W Mueller; Tyree H Kiser Journal: J Thromb Thrombolysis Date: 2022-06-10 Impact factor: 5.221