DOACs in Obese Patients Show Similar VTE Recurrence Rates to Non-Obese Patients

Moustafa Younis, MBBS

The use of direct oral anticoagulants in obese patients is equally efficacious with similar venous thromboembolism recurrence rates compared with non-obese patients.

The findings were presented at the American Thoracic Society annual meeting.

Moustafa Younis, MBBS, and colleagues aimed to assess the rate of venous thromboembolism recurrence in obese patients diagnosed with the condition and treated with direct oral anticoagulants. The team used the Health Facts Center national data warehouse to conduct a retrospective analysis of patients with venous thromboembolism who presented at the hospital between 2010 and 2016 and were treated with direct oral anticoagulants. ICD-9-CM and ICD-10-CM codes were used to identify patients diagnosed with deep vein thrombosis or venous thromboembolism.

Younis and the investigators divided patients into 2 groups based on their weight: less than 120 kg or more than 120 kg. They recorded 6 months of venous thromboembolism recurrence rates.

Overall, the team included 18,147 patients with a mean age of 62 years old. More than half of the patients were female (52%).

Of the patients, 2419 (13%) weight more than 120 kg while the rest (15,728; 87%) weighed less than 120 kg. Significantly more female patients weighed less than 120 kg (54% vs 42%; P <.0001). There were no significant differences in age or tobacco use between both groups (P >.05).

The investigators noted no significant difference in six months readmission rate for venous thromboembolism recurrence in patients that weighed less 120 kg (34%) compared with patients who weighed more than 120 kg (36%) (P=.08).

The findings suggested the use of direct oral anticoagulants in obese patients was equally efficacious with similar venous thromboembolism recurrences rates compared with non-obese patients. Use of direct oral anticoagulants gained significant traction due to the lack of therapeutic monitoring and need for anticoagulant bridging. Data exist on the effectiveness of direct oral anticoagulants in obese patients with venous thromboembolism. In fact, preliminary subgroup and pharmacokinetic analyses demonstrated reduced efficacy in patients with a body weight of more than 120 kg or a body mass index of at least 40 kg per m2.

It is not currently recommended for such agents to be used as first line agents.

“This study paves the way for prospective multi-institutional randomized control trials to further re-enforce the safe use of such agents in this patient population,” the study authors concluded.

The study, “The Use of Direct Oral Anticoagulants in the Management of Venous Thromboembolism in Patients with Obesity,” was published in the American Thoracic Society journal.