TY - JOUR
T1 - Anticoagulation at the extremes of body weight
T2 - choices and dosing
AU - McCaughan, Georgia J B
AU - Favaloro, Emmanuel J
AU - Pasalic, Leonardo
AU - Curnow, Jennifer
PY - 2018/10
Y1 - 2018/10
N2 - INTRODUCTION: The landscape of therapeutic anticoagulation has changed dramatically over the past decade, with availability of direct oral anticoagulants (DOACs), which inhibit factor Xa or thrombin. However, the optimal anticoagulant agent and dosing strategy for patients at both extremes of body weight has not been established for any anticoagulant, including DOACs, vitamin K antagonists (VKA), and the various heparin options. Areas covered: This paper reviews available evidence to assist clinicians in prescribing of anticoagulation therapy at the extremes of body weight. Expert commentary: There are limited data to guide prescribing of all available anticoagulants at the extremes of weight and further research regarding efficacy and safety outcomes in these groups is required. Laboratory monitoring to guide dosing of traditional anticoagulants provides reassurance of 'predictable' efficacy. In contrast agents that are not routinely monitored by laboratory testing provide greater challenges. For example, underweight patients are at risk of receiving higher drug exposures of DOACs, whereas the use of fixed dose DOACs in obese patients may be associated with lower drug exposures.
AB - INTRODUCTION: The landscape of therapeutic anticoagulation has changed dramatically over the past decade, with availability of direct oral anticoagulants (DOACs), which inhibit factor Xa or thrombin. However, the optimal anticoagulant agent and dosing strategy for patients at both extremes of body weight has not been established for any anticoagulant, including DOACs, vitamin K antagonists (VKA), and the various heparin options. Areas covered: This paper reviews available evidence to assist clinicians in prescribing of anticoagulation therapy at the extremes of body weight. Expert commentary: There are limited data to guide prescribing of all available anticoagulants at the extremes of weight and further research regarding efficacy and safety outcomes in these groups is required. Laboratory monitoring to guide dosing of traditional anticoagulants provides reassurance of 'predictable' efficacy. In contrast agents that are not routinely monitored by laboratory testing provide greater challenges. For example, underweight patients are at risk of receiving higher drug exposures of DOACs, whereas the use of fixed dose DOACs in obese patients may be associated with lower drug exposures.
KW - Administration, Oral
KW - Drug Monitoring
KW - Drug Prescriptions
KW - Factor Xa Inhibitors/pharmacokinetics
KW - Female
KW - Humans
KW - Male
KW - Overweight
KW - Risk Factors
KW - Vitamin K/antagonists & inhibitors
U2 - 10.1080/17474086.2018.1517040
DO - 10.1080/17474086.2018.1517040
M3 - Review article
C2 - 30148651
SN - 1747-4094
VL - 11
SP - 817
EP - 828
JO - Expert Review of Hematology
JF - Expert Review of Hematology
IS - 10
ER -