NOACs efficacious in severely obese


By Tony James

22 Nov 2016

Results from a small study presented at last week’s HAA congress suggest non-vitamin K antagonist oral anticoagulants may be efficacious in severely obese patients who have had a venous thromboembolism.

Dr Georgia McCaughan, from Westmead Hospital in Sydney, told delegates said that there was limited data to guide the use of non-vitamin K antagonist oral anticoagulants (NOACs) in obese patients following a venous thromboembolism (VTE).

She and her colleagues identified 12 patients with VTE who weighed more than 120 kg. Their median weight was 137 kg, ranging up to 208 kg, and seven of the patients were female.

Only two patients were commenced NOACs at their first review. The rationale for initially using other anticoagulants included malignancy, renal impairment, cerebral sinus thrombosis and superior mesenteric vein thrombosis.

“Two proximal DVT patients received 4 weeks of enoxaparin prior to NOAC therapy because of efficacy concerns,” she said.

Six patients received apixaban or rivaroxaban with drug levels performed in four, but no NOAC dose adjustments were needed and there were no recurrent thromboses or bleeding complications.

“Clinicians remain hesitant to prescribe NOACs acutely, at body weight extremes, in high risk patients, due to limited data,” Dr McCaughan said.

“Our small sample shows that obese patients may have appropriate rivaroxaban and apixaban levels, and adds to limited data suggesting NOACs may be efficacious in this group.”

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