Use of direct oral anticoagulants for acute pulmonary embolisms in obesity: a propensity-matched, multicentre case–control study. Issue 3 (31st August 2021) - Samaranayake, Chinthaka B.
Direct oral anticoagulants (DOACs) are widely used as first-line treatment for pulmonary embolism (PE) in patients without contraindications [1]; however, limited data exists on the efficacy and safety in obesity. The most recent International Society of Thrombosis and Haemostasis guidelines recommend avoiding DOACs in individuals with body mass index (BMI) >40 kg·m −2 or body weight >120 kg, due to lack of robust clinical efficacy data. Obtaining serum drug levels for therapeutic monitoring in this population has been suggested; however, testing of DOAC levels is neither widely available nor well validated in real-world clinical settings [2]. Given the ongoing uncertainty regarding the clinical outcomes with DOACs in treating acute PE in obese patients, this study aimed to evaluate the efficacy and safety of DOACs compared to warfarin in this population. Assessment of efficacy and safety of DOACs in treatment of pulmonary embolisms in obese patients provides reassurance that treatment with DOACs carries similar rates of recurrent VTE and bleeding complications to warfarin https://bit.ly/2VdrSXX