PMID- 26568174
OWN - NLM
STAT- MEDLINE
DCOM- 20160915
LR  - 20220321
IS  - 1744-764X (Electronic)
IS  - 1474-0338 (Linking)
VI  - 15
IP  - 1
DP  - 2016 Jan
TI  - The use of anticoagulants for the treatment and prevention of venous 
      thromboembolism in obese patients: implications for safety.
PG  - 65-74
LID - 10.1517/14740338.2016.1120718 [doi]
AB  - INTRODUCTION: Obesity is a growing problem and is associated with a high risk of 
      venous thromboembolism (VTE). Clinicians are increasingly challenged with 
      prescribing adequate anticoagulants dosing while balancing the risk of bleeding. 
      AREAS COVERED: In this narrative review, we address the safety of unfractionated 
      heparin (UFH), low-molecular-weight heparins (LMWH), fondaparinux, warfarin and 
      direct oral anticoagulants (DOAC) in obese patients. EXPERT OPINION: Obese 
      patients have been under-represented in clinical trials and, therefore, the 
      optimal dosing for both safety and efficacy in this subgroup remains unknown. 
      Current data are based on pharmacokinetic studies in healthy subjects and 
      small-scale cohort studies not adequately powered to detect differences in 
      bleeding or thrombosis. Weight-based dosing of UFH and LMWH should be used over 
      fixed dosing in most obese patients for VTE treatment and prophylaxis. For 
      fondaparinux, increasing the dose with increasing weight is required for VTE 
      treatment and consideration should be given to increasing the dose for VTE 
      prophylaxis. Regarding the DOAC, they should be administered in fixed-dose 
      regimens in the obese sub-population. Given the increasing prevalence of obesity 
      and the associated increased risk of VTE, further studies are needed to establish 
      the safety and efficacy of anticoagulation dosing regimens.
FAU - Ihaddadene, Ryma
AU  - Ihaddadene R
AD  - a Department of Medicine , University of Ottawa , Ottawa Hospital - General 
      Campus, 501 Smyth Road, Box 201, Ottawa , ON , Canada.
AD  - b The Ottawa Hospital Research Institute , Ottawa , ON , Canada.
FAU - Carrier, Marc
AU  - Carrier M
AD  - a Department of Medicine , University of Ottawa , Ottawa Hospital - General 
      Campus, 501 Smyth Road, Box 201, Ottawa , ON , Canada.
AD  - b The Ottawa Hospital Research Institute , Ottawa , ON , Canada.
AD  - c Thrombosis Program , Division of Hematology, Ottawa Hospital General Campus , 
      Ottawa , ON , Canada.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20151205
PL  - England
TA  - Expert Opin Drug Saf
JT  - Expert opinion on drug safety
JID - 101163027
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Obesity/*complications
MH  - Risk
MH  - Venous Thromboembolism/drug therapy/etiology/*prevention & control
OTO - NOTNLM
OT  - anticoagulants
OT  - bleeding
OT  - drug dosing
OT  - obesity
OT  - venous thromboembolism
EDAT- 2015/11/17 06:00
MHDA- 2016/09/16 06:00
CRDT- 2015/11/17 06:00
PHST- 2015/11/17 06:00 [entrez]
PHST- 2015/11/17 06:00 [pubmed]
PHST- 2016/09/16 06:00 [medline]
AID - 10.1517/14740338.2016.1120718 [doi]
PST - ppublish
SO  - Expert Opin Drug Saf. 2016 Jan;15(1):65-74. doi: 10.1517/14740338.2016.1120718. 
      Epub 2015 Dec 5.