期刊
JOURNAL OF CLINICAL MEDICINE
卷 10, 期 18, 页码 -出版社
MDPI
DOI: 10.3390/jcm10184185
关键词
obesity; atrial fibrillation; direct oral anticoagulants; DOACs; apixaban; dabigatran; edoxaban; rivaroxaban
资金
- Associazione Nazionale Medici Cardiologi Ospedalieri
- Centro servizi ANMCO srl societa' benefit
- Firenze [50121]
DOACs, including dabigatran, rivaroxaban, apixaban, and edoxaban, offer major advantages over VKAs, but concerns remain regarding potential undertreatment in obese patients without specific RCTs comparing the two. Despite limitations, the Italian Association of Hospital Cardiologists has proposed recommendations for the use of DOACs in obese patients based on existing evidence.
The use of the direct oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban (DOACs) offers some major advantages over warfarin and other vitamin K antagonists (VKAs). One advantage is the possibility to use a fixed dose in normal-weight patients, overweight patients and patients with obesity. However, the one size fits all strategy raised a concern regarding the possibility to undertreat patients with a high body mass index. No randomized controlled trials (RCTs) have ever compared VKAs and DOACs in this population. We analyzed data from the literature on DOAC pharmacokinetics and pharmacodynamics, results from the four pivotal phase III trials on non-valvular atrial fibrillation, retrospective observational studies and metanalyses. While we are aware of the limitation imposed by the absence of specific RCTs, we propose the position of the Italian Association of Hospital Cardiologists (ANMCO) on the use of DOACs in patients with obesity based on the existing evidence.
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