Sorodoc Victorita, Asaftei Andreea, Ceasovschih Alexandr, Lionte Catalina, Crisan Simina, Constantin Mihai, Indrei Lucia, Sorodoc Laurentiu
2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania.
Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Front Pharmacol. 2024 Dec 17;15:1457280. doi: 10.3389/fphar.2024.1457280. eCollection 2024.
Obesity is a recognized risk factor for venous thromboembolism (VTE), associated with distinct challenges in managing anticoagulation therapy. There is still limited evidence regarding the impact of extreme body weight on the pharmacokinetics, pharmacodynamics, efficacy, and safety of various anticoagulant medications. To our knowledge, this is the first comprehensive review to address both prophylactic and therapeutic anticoagulant dosages specifically for managing VTE in patients with a body mass index (BMI) ≥40 kg/m or weight ≥120 kg. Our aim was to synthesize the findings of relevant studies alongside the latest recommendations on anticoagulation in this unique population. We gathered and analyzed data on all classes of anticoagulants available for VTE management, including vitamin K antagonists (VKAs), unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, and direct oral anticoagulants (DOACs), offering insights into their efficacy and safety profiles. Additionally, we explored special subpopulations of morbidly obese patients, such as those with cancer, renal dysfunction, or those undergoing bariatric surgery, recognizing the nuanced therapeutic challenges they present. The current evidence for anticoagulant therapy in morbidly obese patients with VTE is evidently insufficient, underscoring the need for a tailored approach and meticulous monitoring to achieve an optimal therapeutic balance.
肥胖是公认的静脉血栓栓塞症（VTE）危险因素，在抗凝治疗管理方面存在独特挑战。关于极端体重对各种抗凝药物的药代动力学、药效学、疗效和安全性的影响，证据仍然有限。据我们所知，这是首次专门针对体重指数（BMI）≥40 kg/m²或体重≥120 kg的患者管理VTE的预防性和治疗性抗凝剂量进行的全面综述。我们的目的是综合相关研究结果以及针对这一特殊人群抗凝治疗的最新建议。我们收集并分析了所有可用于VTE管理的抗凝药物类别的数据，包括维生素K拮抗剂（VKA）、普通肝素（UFH）、低分子肝素（LMWH）、磺达肝癸钠和直接口服抗凝剂（DOAC），深入了解它们的疗效和安全性概况。此外，我们还探讨了病态肥胖患者的特殊亚组，如癌症患者、肾功能不全患者或接受减肥手术的患者，认识到他们所带来的细微治疗挑战。目前，关于病态肥胖VTE患者抗凝治疗的证据明显不足，这突出了需要采用量身定制的方法并进行细致监测以实现最佳治疗平衡的必要性。
