Apixaban in a Morbid Obese Patient with Atrial Fibrillation: A Clinical Experience Using the Plasmatic Drug Evaluation

Vincenzo Russo,1 Andrea Paccone,2 Anna Rago,1 Valeria Maddaloni,3 Dario Iafusco,4 Riccardo Proietti,5 Umberto Atripaldi,3 Antonio D’Onofrio,1 Paolo Golino,1 Gerardo Nigro1 1Chair of Cardiology, University of Campania “Luigi Vanvitelli”- Monaldi Hospital, Naples, Italy; 2Chair of Cardiology, University of Bari “Aldo Moro”, Bari, Italy; 3Chemical Biochemistry Unit, Monaldi Hospital, Naples, Italy; 4Department of Pediatrics, University of Campania “Luigi Vanvitelli”, Naples, Italy; 5Chair of Cardiology, University of Padua, Padua, ItalyCorrespondence: Vincenzo RussoChair of Cardiology, University of Campania “Luigi Vanvitelli”-Monaldi Hospital, Via Leonardo Bianchi, Naples 80126, ItalyTel +39 0817062355Email v.p.russo@libero.itAbstract: We present the case of a 45-year-old man with atrial fibrillation and morbid obesity (weight 128 kg, height 168 cm, BMI 45.4) who was switched from Warfarin 5 mg once daily to Apixaban 5 mg twice daily because he did not achieve at least 60% of the time in therapeutic range. We performed serial determinations of apixaban plasma concentration (at 2, 6, 12, 24 hrs after intake) showing drug levels within reference range, even when the patient lose weight.Keywords: atrial fibrillation, obesity, non-vitamin k oral anticoagulant, plasma levels, apixaban, weight loss