Acute Venous Thromboembolism in Patients with Elevated Body Mass Index, Can We Prescribe Direct Oral Anticoagulants
Background: Due to the efficacy and lower bleeding risk of direct oral anticoagulants (DOACs) compared to coumadin, they are becoming the treatment of choice for acute venous thromboembolism (VTE). There is limited data in using DOAC’s for treatment of VTE (deep vein thrombosis (DVT) or pulmonary embolism (PE)) in patients with morbid obesity (body mass index >40 kg/mm2). We conducted a retrospective study to examine the rates of recurrence (failure of treatment) in patients diagnosed with an acute VTE.
Methods: Electronic health record (EHR) from 8 hospitals in the Beaumont Health system were queried. A retrospective review of patients >18 years old with morbid obesity who were diagnosed with a DVT or PE and treated with a DOAC (rivaroxaban, apixaban or dabigatran) from 2010 to 2020 was performed. Individual charts were reviewed for ultrasound as well as computed tomography angiography results confirming the presence of an acute or chronic DVT or pulmonary embolism. To assess for recurrence, imaging studies performed 3 months after original diagnosis were studied.
Results: 461 patients were included. The mean age was 58.9 years old with a range of 18-88 years old. Majority of patients were female (65.9%). The mean BMI was 46.5 with standard deviation of 7.4. 337 (73.1%) had an acute diagnosis of DVT or PE. When reassessing imaging 3 months after original diagnosis, only 2 (0.6%) patients had findings of recurrence (formation of new DVT or PE).
Conclusion: In patient with morbid obesity, DOACs appear to be an effective therapy for treatment of DVT and PE. Further prospective studies are needed to confirm the findings of this analysis.