Background: Direct oral anticoagulants (DOACs) are approved in most countries for the treatment of venous thromboembolic disease (VTE) and for non-valvular atrial fibrillation (AF). Limited data on anticoagulation dose in patients with morbid obesity are available. The guidelines of the International Society on Thrombosis and Haemostasis (ISTH), recommend the use of DOACs at the usual dose in patients with BMI less or equal than 40kg/m2 and a weight less than 120 kg. Because of the lack of clinical data in patients with a BMI ≥ 40kg / m2 and or a weight above 120kg DOACs are not recommended in this population.

Aims: We aimed to perform a systematic review and meta-analysis of the use of DOACS in morbid obese patients or with a weight above 120kg.

Methods: We performed a systematic literature search of papers published between 01.01.2007 and 01.02.2020. All studies including patients aged 18 years and over with a weight > 120kg and/or a BMI ≥ 40 kg/m2 requiring therapeutic anticoagulation for VTE or for VTE and/or AF were included. Efficacy outcome was recurrent VTE event and the safety outcome was major and non major but clinically relevant bleeding according to the ISTH definition.

Results: Ten studies were published between 01.01.2016 (date of release of the ISTH guidelines) and 01.02.2020 met the pre-established criteria, for a total of 9,711 patients, of which 5,271 under traditional treatment and 4,440 under DOACs.

Conclusions: In regards of outcomes of efficacy and safety compared to traditional treatment (LMWH/AVK), the results are reassuring and suggest that DOACs in this population maintain good efficacy with a good safety profile. For the future, randomized controlled studies targeted to this population are necessary to confirm our data.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/efficacy-and-safety-of-direct-oral-anticoagulants-in-morbidly-obese-patients-with-acute-venous-thromboembolism-a-meta-analysis/