effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review

The international society on thrombosis and haemostasis recommends avoiding the use of direct oral anticoagulants (doacs) in patients with a body mass index (bmi) greater than 40 kg/m2 or weight greater than 120 kg. higher bmi is associated with altered pharmacokinetics which affect the safety and effectiveness for doacs. data were collected on 3458 patients taking a doac prior to admission to a midwestern health system between 2013 and 2016. of these, 43 patients had a thrombotic event and 70 patients had an overt bleeding event. patients were stratified among the following three bmi groups: bmi < 30 kg/m2, bmi 30–40 kg/m2, and bmi > 40 kg/m2. there was no statistically significant difference between bmi groups for thrombotic events (p = 0.598) or for overt bleeding events (p = 0.065). the bmi < 30 kg/m2 had the highest occurrence rate of bleeding events. it was observed that bleeding occurrence decreased as the bmi groups increased. the bmi > 40 kg/m2 group had the lowest risk of bleeding events, and was the only group to have a higher occurrence rate of thrombotic events compared to bleeding events. among patients admitted to a single health system on doac therapy over a three-and-a-half-year period, obesity did not significantly correlate with thrombotic or overt bleeding complications. this study is limited as a single health system study with low overall event rates. a preliminary finding of this study showed a trend towards decreased bleeding frequency as bmi increased.