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Background:Due to the efficacy and lower bleeding risk of direct oral anticoagulants (DOACs) compared to coumadin, they are becoming the treatment of choice for acute venous thromboembolism (VTE). There is limited data in using DOAC’s for treatment of VTE (deep vein thrombosis (DVT) or pulmonary embolism (PE)) in patients with morbid obesity (body mass index >40 kg/mm2). We conducted a retrospective study to examine the rates of recurrence (failure of treatment) in patients diagnosed with an acute VTE.Methods:Electronic health record (EHR) from 8 hospitals in the Beaumont Health system were queried. A retrospective review of patients >18 years old with morbid obesity who were diagnosed with a DVT or PE and treated with a DOAC (rivaroxaban, apixaban or dabigatran) from 2010 to 2020 was performed. Individual charts were reviewed for ultrasound as well as computed tomography angiography results confirming the presence of an acute or chronic DVT or pulmonary embolism. To assess for recurrence, imaging studies performed 3 months after original diagnosis were studied.Results:461 patients were included. The mean age was 58.9 years old with a range of 18-88 years old. Majority of patients were female (65.9%). The mean BMI was 46.5 with standard deviation of 7.4. 337 (73.1%) had an acute diagnosis of DVT or PE. When reassessing imaging 3 months after original diagnosis, only 2 (0.6%) patients had findings of recurrence (formation of new DVT or PE).Conclusion:In patient with morbid obesity, DOACs appear to be an effective therapy for treatment of DVT and PE. Further prospective studies are needed to confirm the findings of this analysis.

Background:The incidence of comorbid obesity and atrial fibrillation (AF) has been increasing. Direct Oral Anticoagulants (DOACs) have become the first-line agents for cerebrovascular accident (CVA) prophylaxis in patients with AF due to their superior efficacy and lower bleeding risk when compared to coumadin. The incidence of acute ischemic CVA while on a DOAC in the non-obese population is 1.2%. Evidence on the efficacy of DOACs in preventing AF related CVAs in the obese population is limited.Methods:Electronic medical records from 8 hospitals within the same health system were queried. Patients age >18 years with a BMI >40 kg/mm2and AF on a DOAC (Rivaroxaban, Apixaban, or Dabigatran) were included in our study. Individual charts from 2010 to 2020 were reviewed for neuroimaging (computed tomography and MRI) following the start date of a DOAC confirming the presence or absence of an acute hemorrhagic or ischemic CVA.Results:We included 1935 patients in the study. Acute ischemic CVA was noted in 17 patients (0.9%) by head CT (11/17 confirmed by MRI). Hemorrhagic CVA was noted in one patient (0.1%) by head CT. 155 (8%) had a head CT without evidence of CVA, of which, 5 (3.2 %) had evidence of an acute ischemic CVA by MRI. Therefore, 22 patients (1.1%) had evidence of acute ischemic CVA on neuroimaging. The remainder of patients (N = 1762, 91.1%) did not have indications for neuroimaging and were considered to have successful CVA prophylaxis. In total, 1912 (98.8%) of patients with a BMI >40 treated with a DOAC for AF did not demonstrate neuroimaging evidence of CVA.Conclusions:Although we expected to find higher CVA rates due to ineffective anticoagulation in the obese population, DOACs appear to be an effective therapy for CVA prophylaxis in obese patients with AF. The incidence of acute ischemic CVA in the obese population while on a DOAC is comparable to the non-obese population. Further prospective studies are needed to confirm the findings of this analysis.