Vnitr Lek 2024, 70(1):60-65 | DOI: 10.36290/vnl.2024.011

Recommended dosing of anticoagulants in times of obesity pandemic

Alena Pilková

Farmakologický ústav 1. lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice, Praha

Anticoagulants are an important therapeutic group of drugs used in the prevention and treatment of thromboembolic disease. Despite their widespread use, many questions remain unanswered regarding their dosage in the growing group of obese patients. Published studies indicate that an increase in prophylactic dose of parenteral anticoagulants may be appropriate, although for the most studied drug, enoxaparin, various recommendations lead to significant dosing differences for patients with higher degree of obesity. Therapeutic dosing of enoxaparin should be kept at the standard 1 mg/kg twice daily up to the weight of approx. 150 kg. The growing experience with direct oral anticoagulants in obese patients with atrial fibrillation shows comparable efficacy and safety, rivaroxaban and apixaban are preferred for treatment and prevention of thromboembolic disease. Anticoagulation after bariatric surgery represents a unique challenge, and low molecular weight heparins or apixaban are drugs of choice, especially shortly after the surgery. In addition to weight or BMI, other factors such as age, polypharmacy and elimination functions must always be considered when deciding on the appropriate drug and dose in a patient with obesity, and it is advisable to assess relevant coagulation parameters, and in same cases also drug levels.

Keywords: atrial fibrillation, BMI, DOAC, heparin, low molecular weight heparins, thromboembolism, warfarin.

Accepted: February 9, 2024; Published: February 26, 2024  Show citation