1. Direct Oral Anticoagulants in Patients with Obesity and Atrial Fibrillation: Position Paper of Italian National Association of Hospital Cardiologists (ANMCO)
- Author
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David Mocini, Pasquale Caldarola, Carlo Lavalle, Domenico Gabrielli, Lorenzo M. Donini, Andrea Di Lenarda, Carmine Riccio, Furio Colivicchi, Stefania Angela Di Fusco, Fabrizio Oliva, Leonardo De Luca, Michele Massimo Gulizia, and Edoardo Mocini
- Subjects
obesity ,medicine.medical_specialty ,Population ,apixaban ,Review ,direct oral anticoagulants ,law.invention ,Dabigatran ,chemistry.chemical_compound ,Randomized controlled trial ,law ,Edoxaban ,Medicine ,atrial fibrillation ,dabigatran ,Intensive care medicine ,education ,rivaroxaban ,education.field_of_study ,Rivaroxaban ,business.industry ,Warfarin ,General Medicine ,DOACs ,chemistry ,edoxaban ,Observational study ,Apixaban ,Atrial fibrillation ,Direct oral anticoagulants ,Obesity ,business ,medicine.drug - Abstract
The use of the direct oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban (DOACs) offers some major advantages over warfarin and other vitamin K antagonists (VKAs). One advantage is the possibility to use a fixed dose in normal-weight patients, overweight patients and patients with obesity. However, the “one size fits all” strategy raised a concern regarding the possibility to undertreat patients with a high body mass index. No randomized controlled trials (RCTs) have ever compared VKAs and DOACs in this population. We analyzed data from the literature on DOAC pharmacokinetics and pharmacodynamics, results from the four pivotal phase III trials on non-valvular atrial fibrillation, retrospective observational studies and metanalyses. While we are aware of the limitation imposed by the absence of specific RCTs, we propose the position of the Italian Association of Hospital Cardiologists (ANMCO) on the use of DOACs in patients with obesity based on the existing evidence.
- Published
- 2021
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