Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston.
Frankel Cardiovascular Center, University of Michigan, Ann Arbor.
Am J Med. 2023 Jun;136(6):523-533. doi: 10.1016/j.amjmed.2023.01.010. Epub 2023 Feb 16.
In clinical practice, direct oral anticoagulants (DOACs) are increasingly used for venous thromboembolism treatment and prevention. A substantial proportion of patients with venous thromboembolism are also obese. International guidance published in 2016 stated that DOACs could be used in standard doses in patients with obesity up to a body mass index (BMI) of 40 kg/m, but should not be used in those with severe obesity (BMI >40 kg/m) owing to limited supporting data at the time. Although updated guidance in 2021 removed this limitation, some health care providers still avoid DOACs even in patients with lower levels of obesity. Furthermore, there are still evidence gaps regarding treatment of severe obesity, the role of peak and trough DOAC levels in these patients, use of DOACs after bariatric surgery, and appropriateness of DOAC dose reduction in the setting of secondary venous thromboembolism prevention. This document describes proceedings and outcomes of a multidisciplinary panel convened to review these and other key issues regarding DOAC use for treatment or prevention of venous thromboembolism in individuals with obesity.
在临床实践中，直接口服抗凝剂（DOACs）越来越多地用于治疗和预防静脉血栓栓塞症。很大一部分静脉血栓栓塞症患者也肥胖。2016 年发表的国际指南指出，DOACs 可用于体重指数（BMI）高达 40kg/m2 的肥胖患者的标准剂量，但不应用于严重肥胖（BMI >40kg/m2）患者，因为当时数据有限。尽管 2021 年的更新指南删除了这一限制，但一些医疗保健提供者仍避免在肥胖程度较低的患者中使用 DOACs。此外，在严重肥胖患者中，DOAC 水平的峰值和谷值的作用、肥胖患者减重手术后 DOAC 的使用以及二级预防静脉血栓栓塞症时 DOAC 剂量减少的适当性等方面仍存在证据空白。本文描述了一个多学科小组审议这些问题和其他与 DOAC 用于肥胖个体静脉血栓栓塞症治疗或预防相关的关键问题的会议过程和结果。
