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Thromb Res. 2020 Jan 11;187:56-62. doi: 10.1016/j.thromres.2020.01.011. [Epub ahead of print]

Anticoagulant therapies and outcomes in obese patients with acute venous thromboembolism.

Author information

1
Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: Steven.Quan@ahs.ca.
2
Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: Jenna.Smith3@ahs.ca.
3
Division of Hematology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: Cwu@ualberta.ca.
4
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: skoshman@ualberta.ca.
5
Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: Binh.Nguyen@ahs.ca.
6
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: tammy.bungard@ualberta.ca.

Abstract

BACKGROUND:

Direct oral anticoagulants (DOACs) are recommended in preference to traditional anticoagulants (LMWH ± warfarin) for treating acute venous thromboembolism (VTE). However, guidelines suggest avoiding DOACs in those >120 kg given limited data.

OBJECTIVE:

To capture outcome and prescription fill data in a cohort of patients >120 kg with acute VTE out to 1 year.

METHODS:

Using linked administrative data, a retrospective sub-study of obese patients (>120 kg) with acute VTE discharged from institutions from 2014 to 2017 was performed. Primarily, the overall rate of recurrent VTE was assessed. Secondarily, anticoagulant regimens (agent/dosing) and bleeding events were recorded with recurrent events confirmed by chart reviews. Outcomes were compared between DOACs and traditional therapies.

RESULTS:

Amongst 187 patients included, the overall rate of recurrent VTE out to 1 year was 0.006 events/patient year, and the only event during the entire follow-up occurred off therapy. Throughout the year, 38.5% were prescribed a DOAC only, 32.6% were prescribed traditional therapy only and 23.5% were switched from LMWH/warfarin to a DOAC. The proportion of patients receiving sub-therapeutic, standard or supra-therapeutic regimens were: DOAC (11.1%, 85.2%, 3.7%), LMWH (24.2%, 71.0%, 4.8%), warfarin (30.4%, 55.0%, 15.0%). Bleeding occurred in 9 (8.3%) and 9 (11.5%) patients on DOAC and traditional therapy, respectively (relative risk 0.85 [95%CI 0.44-1.28]).

CONCLUSIONS:

More obese patients with acute VTE were prescribed DOACs than traditional therapies. Standard dosing was used for DOACs (85.2%), whereas sub-optimal dosing occurred for 25-33% receiving traditional therapies. Rates of recurrent VTE and bleeding were similar in the two groups, lending support for DOAC use in this population.

KEYWORDS:

Anticoagulants; Bleeding; Obesity; Pulmonary embolism; Venous thromboembolism

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