Topics:
Thrombosis • Hematology • Benign Hematology • Hemostasis/Thrombosis • Pulmonology • Pulmonary Vascular Disease • Pulmonary Embolus
How would you manage a patient with morbid obesity who presents with new symptomatic pulmonary embolism a few days after he was started on DOAC for DVT?
What is your preferred anticoagulation in patients with BMI >50?
Answer from: at Community Practice
I am comfortable giving DOACs to patients with high BMI based on the data outlined by Dr. @Kraut, unless they have had gastric surgery for weight loss. I would wonder if this "new" PE was actually there at the time of the DVT diagnosis based on older studies that 30%-50% of patients with DVT have as...
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Answer from: Medical Oncologist at Academic Institution
There are guidelines from the American Society of Hematology and The International Society of Hemostasis and Thrombosis as well as expert opinions recommending either apixaban or rivaroxaban for venous thromboembolism or pulmonary embolism in patients with BMI >40. In addition, this includes use ...
Answer from: at Academic Institution
One additional point here is that when patients fail anticoagulation, especially when further out from the acute setting, one should consider looking for cancer. While a cancer eval is generally not necessary in most acute VTE cases, AC failure merits special attention. Recurrence on a DOAC, or an a...
Answer from: Medical Oncologist at Community Practice
I would not recommend using DOAC in the obese population, BMI > 35-40, since there is little data on obese patients on DOAC. I would also be concerned that fixed dosing in a morbidly obese patient may have lower drug level and lower efficacy.
Also, I believe the safety data on DOACs, are mostly ...