Dah Kingsley, Porres-Aguilar Mateo, la Rosa Alan De, Prakash Swathi
Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, Texas, USA.
J Vasc Bras. 2023 Jun 30;22:e20230056. doi: 10.1590/1677-5449.202300562. eCollection 2023.
Direct oral anticoagulants (DOACs) have become the standard of care for acute and long-term therapy for venous thromboembolism (VTE) due to their efficacy and safety profiles. The 2021 International Society on Thrombosis and Haemostasis guidelines recommend using standard DOAC dosages in patients with BMI >40 kg/m or weight >120 kg. Use of DOACs remains uncertain in morbidly obese patients with VTE, including acute PE. A morbidly obese woman in her 30s who presented with acute worsening of dyspnea was diagnosed with acute intermediate-high risk acute pulmonary embolism and concomitant proximal deep vein thrombosis, constituting a clinically challenging scenario for treating her with rivaroxaban. Standard doses of rivaroxaban for acute and extended phase treatment of venous thromboembolism in individuals with morbid obesity at BMI>70 kg/m may be effective, and safe.
直接口服抗凝剂（DOACs）因其有效性和安全性，已成为静脉血栓栓塞症（VTE）急性和长期治疗的标准疗法。2021年国际血栓形成和止血协会指南建议，体重指数（BMI）>40 kg/m²或体重>120 kg的患者使用标准DOAC剂量。在包括急性肺栓塞（PE）在内的病态肥胖VTE患者中，DOACs的使用仍不明确。一名30多岁的病态肥胖女性因呼吸困难急性加重就诊，被诊断为急性中高危急性肺栓塞并伴有近端深静脉血栓形成，这给用利伐沙班治疗她带来了临床挑战。对于BMI>70 kg/m²的病态肥胖个体，利伐沙班用于静脉血栓栓塞症急性和延长阶段治疗的标准剂量可能是有效且安全的。
