scholarly journals Rivaroxaban versus warfarin treatment among morbidly obese patients with venous thromboembolism: Comparative effectiveness, safety, and costs

2019 ◽  
Vol 182 ◽  
pp. 159-166 ◽  
Author(s):  
Alex C. Spyropoulos ◽  
Veronica Ashton ◽  
Yen-Wen Chen ◽  
Bingcao Wu ◽  
Eric D. Peterson
Keyword(s):  
Venous Thromboembolism ◽  
Comparative Effectiveness ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Warfarin Treatment

scholarly journals Comparative effectiveness, safety, and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation

2019 ◽  
Vol 212 ◽  
pp. 113-119 ◽  
Author(s):  
Eric D. Peterson ◽  
Veronica Ashton ◽  
Yen-Wen Chen ◽  
Bingcao Wu ◽  
Alex C. Spyropoulos
Keyword(s):  
Atrial Fibrillation ◽  
Comparative Effectiveness ◽  
Morbidly Obese ◽  
Obese Patients

The Morbidly Obese Surgical Patient

2020 ◽  
Author(s):  
Michael A. Schweitzer ◽  
Gregory Grimberg
Keyword(s):  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Venous Thromboembolism ◽  
Sleep Apnea ◽  
Children And Adolescents ◽  
Respiratory Insufficiency ◽  
Gastric Surgery ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep

Over the past few decades, the incidence of obesity has been steadily rising in the United States. The Centers for Disease Control and Prevention estimates greater than 40% of the US adult population is obese. Rising obesity rates are also increasing among children and adolescents as well, with nearly one in five children and adolescents considered obese. As a result, surgeons today face the challenge of caring for an increasing number of morbidly obese patients, and this trend is expected to worsen over time. This review covers preoperative evaluation, obesity-related comorbidities, respiratory insufficiency, anesthesia in patients with respiratory insufficiency, intraoperative management, postoperative management, complications of gastric surgery for obesity, diabetes mellitus, wound care, and other obesity-related diseases. Figures show impaired pulmonary function in the morbidly obese improved significantly after weight loss induced by bariatric surgery, significant improvement in mean pulmonary arterial pressure in 18 patients, 3 to 9 months after gastric surgery-induced weight loss of 42% ± 19% of excess weight, and a chronic venous stasis ulcer present for several years in a morbidly obese patient. The tables list evaluation and treatment of obstructive sleep apnea, and indications for extended postoperative chemoprophylaxis for venous thromboembolism in morbidly obese patients. This review contains 3 highly rendered figures, 2 tables, and 46 references Keywords: morbid obesity, obesity, metabolic surgery, venous thromboembolism chemoprophylaxis, Obstructive Sleep Apnea

Abstract 14569: Direct Oral Anticoagulants in the Treatment of Acute Venous Thromboembolism in Obese Patients: A Systematic Review With Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Vicky Mai ◽  
Emmanuelle Marceau-Ferron ◽  
Laurent BERTOLETTI ◽  
Yves Lacasse ◽  
Sebastien Bonnet ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Data Extraction ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Random Effect ◽  
Random Effect Model ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Efficacy And Safety

Background: Obesity is a real burden and its prevalence is constantly increasing. High body weight is a risk factor for developing venous thromboembolism (VTE). Direct oral anticoagulants’ (DOAC) pharmacokinetics and pharmacodynamics are affected by obesity. Their efficacy and safety in obese (BMI ≥30kg/m 2 ) and morbidly obese (BMI ≥40kg/m 2 ) patients are still unclear in the treatment of VTE. Objectives: To compare the efficacy and safety of DOAC with vitamin K antagonist (VKA)/low molecular weight heparin (LMWH) in the acute treatment of VTE in obese and morbidly obese patients. The primary efficacy outcome was VTE recurrences. The safety outcomes were major bleeding (MB) and clinically relevant non-MB (CRNMB). All-cause mortality was also assessed. Hypothesis: We hypothesized that DOAC would present the same efficacy and safety for the treatment of acute VTE in obese and morbidly obese patients compared to VKA/LMWH. Methods: A systematic literature search (MEDLINE, EMBASE, CENTRAL, Web of Science) was conducted from inception to April 15 th 2020, identifying trials studying DOAC in the treatment of acute VTE in obese patients. Studies were included if one of the outcomes was reported. Two independent reviewers performed the study selection, data extraction, risk of bias assessment and strength of body evidence evaluation using the GRADE methodology. Analyses were conducted using the Mantel-Haenszel method based on a random-effect model. Relative risks (RR) were estimated for the effect measure with 95% confidence intervals. Results: From 1240 citations screened, we included 21 studies (58,590 patients). VTE recurrences was similar with DOAC compared to VKA/LMWH in obese patients (risk ratio (RR): 1.03; 95%CI 0.93-1.15; p=0.55) and morbidly obese patients (RR 1.06; 95CI 0.94-1.19; p=0.35). DOAC was associated with a reduction in MB in obese patients (RR 0.57; 95%CI 0.34-0.94; p=0.03) and morbidly obese patients (RR 0.71; 95%CI 0.50-1.00; p=0.05) compared to VKA/LMWH. In obese patients, no difference was observed in CRNMB with DOAC compared to VKA/LMWH. Conclusion: DOAC is as effective in reducing VTE and is associated with less MB compared to VKA/LMWH in obese and morbidly obese patients.

Implementation of an Enoxaparin Protocol for Venous Thromboembolism Prophylaxis in Obese Surgical Intensive Care Unit Patients

2011 ◽  
Vol 45 (11) ◽  
pp. 1356-1362 ◽  
Author(s):  
Kyle P Ludwig ◽  
Heidi J Simons ◽  
Mary Mone ◽  
Richard G Barton ◽  
Edward J Kimball
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Factor Xa ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Surgical Intensive Care ◽  
Vte Prophylaxis

Background:: Venous thromboembolism (VTE) is a serious health care issue that affects a large number of people. Few standards exist for delineating the optimal dosing strategy for VTE prevention in obese patients, especially in the setting of major surgery or trauma. Objective: To document the efficacy of a surgical intensive care unit (SICU)–specific, weight-based dosing protocol of enoxaparin 0.5 mg/kg given subcutaneously every 12 hours for VTE prophylaxis in morbidly obese (defined as body mass index [BMI] ≥35 kg/m2 or weight ≥150 kg) SICU patients, using peak anti-factor Xa levels to determine therapeutic endpoints. Methods: Data were collected retrospectively in an academic, university-based SICU on 23 morbidly obese patients who received weight-based enoxaparin for VTE prophylaxis from December 1, 2008, through June 30, 2010. Results: A weight-based dosage range of enoxaparin 50-120 mg twice daily (median 60) was given to 23 patients. The mean BMI was 46.4 kg/m2. The initial mean anti-factor Xa level (measured after the third dose) was 0.34 IU/mL (range 0.20-0.59). Patients received an average of 18 doses. Two cases required an increase or decrease in dosage based on anti-factor Xa levels. Morbidity related to this dosing included a single event of minor endotracheal bleeding and a single deep vein thrombosis that was likely present prior to treatment. Conclusions: Weight-based dosing with enoxaparin in morbidly obese SICU patients was effective in achieving anti-factor Xa levels within the appropriate prophylactic range. This regimen reduced the rate of VTE below expected levels and no additional adverse effects were reported.

Sign in / Sign up

Export Citation Format

Share Document