Salmon Thomas, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Expert Opin Pharmacother. 2025 Mar;26(4):381-431. doi: 10.1080/14656566.2025.2462766. Epub 2025 Mar 17.
The relationship between anticoagulation efficacy and safety in obesity is complex and can vary between degrees of obesity and anticoagulant choice. Indeed, patients at extremes of body weight were under-represented in randomized trials. Additionally, the possibility of an 'obesity paradox' has been raised in atrial fibrillation, describing decreased thromboembolic risk in obese patients.
We explore the current literature on anticoagulation in obesity, specifically with regard to efficacy in atrial fibrillation, efficacy in venous thromboembolism, and bleeding risk. Pharmacodynamic and pharmacokinetic considerations are also discussed.
As a class, direct oral anticoagulants are comparable to vitamin-K antagonists in preventing and treating thromboembolism in overweight and obese patients, whilst not increasing bleeding risk.
肥胖人群中抗凝疗效与安全性之间的关系较为复杂，且会因肥胖程度和抗凝剂选择的不同而有所差异。实际上，体重处于极端水平的患者在随机试验中的代表性不足。此外，心房颤动中出现了“肥胖悖论”的可能性，即肥胖患者的血栓栓塞风险降低。
我们探讨了目前关于肥胖人群抗凝治疗的文献，特别是在心房颤动中的疗效、静脉血栓栓塞中的疗效以及出血风险。还讨论了药效学和药代动力学方面的考虑因素。
作为一类药物，直接口服抗凝剂在预防和治疗超重及肥胖患者的血栓栓塞方面与维生素K拮抗剂相当，同时不会增加出血风险。
