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Which is the anticoagulant of choice for morbidly obese patients?

Due to its constantly growing incidence, obesity is an increasingly serious social and medical problem. Available data on the use of novel oral anticoagulants in morbidly obese and obese patients are very limited. However, we tried to summarize the available knowledge on the use of anticoagulants in Evidence for DOAC use in the obese for VTE and AF In recent years, DOACs have become the preferred anticoagulant for both VTE and AF for the general population. 17,18 However, the efficacy and safety of DOACs in a few selected populations remain controversial, including in morbidly obese patients The efficacy of DOACs over warfarin in obese patients with AF is less defined and may carry the potential for sub therapeutic anticoagulation a Direct Oral Anticoagulant Choice for Stroke Prevention in Obese Patients with Atrial Fibrillation Can J Cardiol. 2021 Apr 15;S0828-282X (21)00210-5. for venous thromboembolism (VTE) and the development of atrial fibrillation. While warfarin remains the most commonly prescribed oral anticoagulant worldwide, direct oral anticoagulants (DOACs) offer fewer drug and dietary interactions and do not require routine lab monitoring, making them enticing options for many patients

Obesity has also been linked to the expanding incidence of atrial fibrillation (AF), with a 49% increased risk in obese individuals compared with non-obese individuals. 2 Therapeutic interventions for AF typically involve antiarrhythmic drugs (AADs) and/or anticoagulation, of which direct oral anticoagulants (DOACs) are preferred due to rapid onset of action, fewer monitoring parameters, and standard dosing In 2016, the International Society on Thrombosis and Haemostasis (ISTH) published a guidance document, Use of the direct oral anticoagulants in obese patients. 17 It highlighted that, while subgroup analyses of obese patients from the large phase III DOAC vs warfarin trials suggest that DOACs are efficacious and safe in obese patients, this conclusion must be tempered by the paucity of available data on patients at extremes of weight on the use of novel oral anticoagulants in morbidly obese patients. Incomplete data are is the anticoagulant drug class of choice for the prevention of thrombosis during pregnancy and often. Abstract. Title: Choice of Anticoagulation in the Obese Background: The optimal anticoagulation strategy in the obese is unclear. There is limited available data to guide the use of DOACs and low. Given the limited data regarding treatment of VTE in patients who are morbidly obese (body mass index [BMI] of 40 kg per m 2 or more) and that the current prevalence of morbid obesity in the United..

In 2012, a prospective study was conducted by Freeman et al to evaluate three different dosing regimens of enoxaparin in morbidly obese patients that were hospitalized and medically ill. In the 31 patients included in the study, peak anti-Xa levels were assessed in patients receiving fixed-dose enoxaparin of 40 mg daily, weight-based low dos Since a randomised clinical trial comparing direct oral anticoagulants with warfarin in morbidly obese patients with atrial fibrillation or venous thromboembolism is unlikely to ever be done, observational studies such as Kushnir and colleagues' 8 could provide valuable information to guide management in this specific and growing population In 2016, the International Society on Thrombosis and Haemostasis (ISTH) published guidelines advising caution when using direct oral anticoagulants (DOACs) in patients with morbid obesity due to limited clinical efficacy and safety data supporting their use in this patient population

The use of anticoagulants in morbidly obese patient

Results from a new real-world study evaluating rivaroxaban (Xarelto; Janssen), a factor Xa inhibitor, in morbidly obese patients were recently published in Thrombosis Research It also underlines some of the challenges surrounding anticoagulation in the obese patient, including choice of therapeutic agent, dosing considerations and logistical issues. Case presentation A 61-year-old man with a history of morbid obesity, obstructive sleep apnoea and unprovoked pulmonary embolism presented to the emergency department. Start studying Anticoagulant. Learn vocabulary, terms, and more with flashcards, games, and other study tools

How I treat obese patients with oral anticoagulants

Video: Direct Oral Anticoagulant Choice for Stroke Prevention in

Abstract Direct oral anticoagulant (DOAC) agents are becoming the anticoagulation strategy of choice. However, their use in the treatment of acute venous thromboembolism (VTE) in morbidly obese patients (bodyweight of > 120 kg or BMI > 40 kg/m 2) guarded. This is due to the scarce data supporting their use in this population The Journal of Thrombosis and Haemostasis (JTH) has accepted the following article on guidance from the Scientific and Standardization Committee (SSC) of the ISTH:. Use of the direct oral anticoagulants in obese patients: Four direct-acting oral anticoagulants (DOACs) - the thrombin inhibitor dabigatran, and the activated factor X (FXa) inhibitors apixaban, edoxaban, and rivaroxaban - are.

Antiarrhythmic and DOAC Dosing in Obesity - American

  1. K antagonist (VKA) or low molecular weight heparin (LMWH) for the treatment of venous thromboembolism (VTE) generally exclude patients who are morbidly obese (body mass index ≥ 40 kg/m2 or weight ≥ 120 kg). Recently, smaller studies have compared DOACs with warfarin or.
  2. K antagonists (VKA) in morbidly obese patients with atrial fibrillation (AF). We compared the efficacy and safety of DOAC in obese patients and non-obese patients with AF
  3. In an observational cohort of higher-risk PE patients, DOAC therapy in morbidly obese patients was not associated with an increased risk of recurrent VTE compared to warfarin anticoagulation therapy within 6 months of management of acute PE, and these higher-risk patients had similar recovery of right ventricle function on DOAC therapy as those.
  4. imum of 12 months continuous plan enrollment prior to and 3 months post treatment initiation, were included in the ITT analysis

In morbidly obese patients, indirect calorimetry is considered the method of choice to determine energy expenditure if the inspired oxygen is less than 60%. System leaks, the effect of water vapor pressure, and errors in calibration can all contribute, however, to erroneous values Patients with class 2 or 3 obesity (BMI ≥35 kg/m 2) were younger than patients with normal BMI (64±11 versus 69±12 years; P<0.001). Patients with obesity also had higher rates of hypertension and diabetes mellitus, but lower rates of prior transient ischemic attack or stroke Jennings, ST, Manh, KNP, Bita, J. Morbidly obese patient on rivaroxaban presents with recurrent upper extremity deep vein thrombosis: a case report [published online June 23, 2019]. J Pharm Pract. doi: 10.1177/089719001985135 MORBIDLY OBESE PATIENTS Obesity is an increasing health risk for Americans, occurring in approximately one third of both men and women. Obesity is an important risk factor for thrombosis, and VTE is common in obese patients. LMWH has theoretic advantages in obese patients as a result of superior subcutaneous bioavailability • For weight-based anticoagulation, the patient's actual weight in kg is used. • Morbidly obese individuals may be dosed too high if total actual body weight is used. • Heparin PowerPlans cap off bolus dosing and initial infusion rate to avoid overdosing morbidly obese individual

Direct oral anticoagulants in extremely obese patients: OK

Morbidly Obese Animals

Introduction Direct Oral Anticoagulants (DOACs) are rapidly replacing warfarin as drugs of choice for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF). Advantage of DOACs over warfarin include fixed dosing, predictable pharmacokinetics, less interaction with food/ medication and no requirement for frequent monitoring of their therapeutic efficacy. Obesity is a risk. 1. Extreme obesity - 2patients with a BMI > 40 kg/M 2. Renal dysfunction - patients with a CrCl< 30 mL/min or evidence of stage 4 [eGFR 15-29 mL/min/1.73M2] or 5 [eGFR < 15 mL/min/M2] renal dysfunction 3. Mechanical prophylaxis - methods may include graduated compression stockings (GCS) Warfarin is the preferred choice of anticoagulation in patients with morbid obesity or altered gastrointestinal absorption, such as after gastric bypass surgery. Direct-acting oral anticoagulants (DOACs) are commonly used as anticoagulants given their ease of administration, equivalent reduction in stroke Warfarin is the preferred choice of anticoagulation in patients with morbid obesity or altered gastrointestinal absorption, such as after gastric bypass surgery. Direct-acting oral anticoagulants (DOACs) are commonly used as anticoagulants given their ease of administration, equivalent reduction in stroke, and lesser bleeding risk than vitamin.

(PDF) The use of anticoagulants in morbidly obesity patient

Medications used for supportive care or prophylaxis constitute a significant portion of drug utilization in the intensive care unit. Evidence-based guidelines are available for many aspects of supportive care but drug doses listed are typically for patients with normal body habitus and not morbid obesity. Failure to account for the pharmacokinetic changes that occur with obesity can lead to an. Anaesthesia and morbid obesity. Continuing Education in Anaesthesia, Critical Care & Pain | Volume 8 Number 5 2008. Peri-operative management of the obese surgical patient 2015. Anaesthesia 2015, 70, pages 859-876. Airway management in obese patients.Current Anaesthesia & Critical Care 21 (2010) 9-15 Introduction. Obesity and atrial fibrillation (AF) often coexist. Atrial fibrillation has rapidly become a global epidemic, and with the burgeoning obesity epidemic, it is expected to remain a significant cause of cardiovascular morbidity and mortality. 1 Although weight loss in obese individuals may reduce the burden of AF, the continuous variation in weight over time may diminish this effect.

Choice of Anticoagulation in the Obese Request PD

Our retrospective study provides further evidence of similar efficacy and safety between the direct oral anticoagulants apixaban and rivaroxaban, and warfarin in morbidly obese patients with atrial fibrillation and venous thromboembolism. These data, if confirmed in prospective studies, might enable patients with a BMI of at least 40 kg/m2 to benefit from more convenient, and possibly safer. Studies of obese patients on warfarin have shown that these patients have lower initial response and take longer to reach therapeutic levels vs non-obese individuals. Rivaroxaban is an agent in the new class of direct-acting oral anticoagulants (DOACs). Studies have suggested that rivaroxaban may not require dose adjustment in obese patients Choice of Anticoagulant: Example Approach Proportion of Obese Patients (%) Dabigatran RE‐COVER I/II RE‐LY VTE AF ≥ 35kg/m2 ≥ 100 kg 12.1 ENGAGE AF‐TIMI 48 VTE AF > 100 kg None 14.8 NR NR = Not Reported DOACs in Morbidly Obese Study,Year N Indication Weight, k Introduction. Obesity is defined as abnormal or excessive fat accumulation that may impair health 1, 2.BMI is a simple measure for classifying overweight and obesity in adults: BMI over 25 kg/m 2 and exceeding 30 kg/m 2 respectively 1, 2.The WHO 1, 2 categorizes obesity as grade I (BMI 30-34 kg/m 2), grade II (BMI 35-39 kg/m 2) or grade III (BMI at least 40 kg/m 2) Choice of anticoagulant for DVT / PE. Warfarin is no longer preferred for most patients (CHEST Guidelines 2016) Low risk patients: Start them on a DOAC. Dr Streiff likes apixaban better than rivaroxaban if he has a choice, but either is approved

Morbidly Obese - Imgflip

Treatment of Venous Thromboembolism in Patients Who Are

with Anticoagulants and Antiplatelet Therapies. (patients with active cancer, morbid obesity or very low body weight, pregnant women, nursing mothers, patients with serious thrombophilic defects, or those requiring • Warfarin is the agent of choice in patients with renal failure, anti-phospholipid antibody syndrome, valvula The efficacy of DOAC in patients with morbid obesity (BMI ≥ 40 kg/m 2) and AF may not be different to VKA in preventing stroke and systemic embolism. In addition, major bleeding risk may be lower in morbidly obese patients with AF who are treated with DOAC compared to standard treatment of warfarin This Centers of Excellence program was created by the Anticoagulation Forum, the leading organization of healthcare professionals working to improve the quality of care for patients taking antithrombotic medications. More than 30 anticoagulation physicians, pharmacists, and nurse experts have worked together to create this resource Fatty liver is commonly observed in morbidly obese patients. It is the most common cause for elevated transaminases in the United States. The risk of steatosis increases with type 2 diabetes. Background: The International Society of Thrombosis and Haemostasis recommends avoiding direct oral anticoagulants (DOACs) in morbidly obese patients with a body mass index (BMI) >40 kg/m 2 or weight >120 kg because of limited clinical data in this group of patients. Objectives: The objective of this study was to evaluate the efficacy and safety of DOACs in morbidly obese patients with atrial.

Direct oral anticoagulants and obesity: one size fits all

UFH is the preferred treatment for patients at high risk of bleeding complications, due to its short activity and reversibility. It is also less reliant on the kidneys for excretion than other heparins, so it is the treatment of choice for morbidly obese patients, individuals who are significantly underweight, and any other patients with known. Patients were identified who were initiated on XARELTO ® or warfarin (first pharmacy claim date was the index date), who had ≥1 medical claim with an AF diagnosis during the past 12 months prior to or on the index date, and ≥1 medical claim for morbid obesity. Patients were required to have continuous enrollment 12 months before index date. in patients on warfarin with atrial fibrillation and/or venous thromboembolism • Determine optimal oral anticoagulant based on patient‐specific characteristics • Recommend appropriate monitoring for direct oral anticoagulants Evolution of Anticoagulation 180A.D. 1939 1952 1985‐1993 1997‐2000 2003 2008‐2015 Hirud However, one of the key points that I try to make, if somebody is at high bleeding risk, you're going to stop anticoagulation after three months, but if they're low to moderate risk, you might wanna consider indefinite therapy with anticoagulants. But if you are gonna stop the anticoagulation, then adding aspirin is a great choice

In morbidly obese patients, indirect calorimetry is considered the method of choice to determine energy expenditure if the inspired oxygen is less than 60%. System leaks, the effect of water vapor pressure, and errors in calibration can all contribute, however, to erroneous values Among all the patients with obesity in the pooled sample, 39.5% were identified as morbidly obese. PSM resulted in 6310 apixaban-warfarin, 2342 dabigatran-warfarin, 8055 rivaroxaban-warfarin, 2373 apixaban-dabigatran, 7180 apixaban-rivaroxaban, and 2617 dabigatran-rivaroxaban pairs of patients America is amidst an obesity epidemic that is estimated to affect 39% of the adult population [1]. The Center of Disease Control and Prevention defines obesity as a body mass index (BMI) ≥ 30 kg/m 2, morbid or severe obesity as BMI ≥ 40 kg/ m 2, and healthy weight as a BMI of 18 to 25 kg/m 2.Obese patients have a 2-fold increased risk for development of venous thromboembolism (VTE), and a. Initial Choice of Anticoagulation ASH Guidelines -QUIZ!!!! Q: Who should probably NOTreceive direct acting anticoagulants as initial outpatient therapy for VTE? A: At least 5 answers (MOLAR) Patients with active Malignancy and VTE Morbid Obesity Moderate to severe Liver disease Antiphospholipid syndrom

97.31 and 122.5 min in the normal, overweight, obese and morbidly obese respectively (p=0.01). Stone free rate was 52% in the normal BMI group, 62% in the overweight, 66% in the obese and 50% in the morbidly obese (p=0.268). Conclusion: PCNL in obese patients, BMI>25 kg/m2, was associated with a longe Morbidly obese patients are at a higher risk of development of various serious complications during postoperative period and prolonged ICU stay. Harris-Benedict equation is the commonly used equation which is based on actual body weight for calculation of total metabolic energy requirements of critically ill patients The purpose of this study is to assess anticoagulation parameters in obese and non-obese patients in an intensive care unit (ICU) setting who received argatroban treatment during their stay. Methods: This is a retrospective, observational, single-centered study. Participants of the study must be adults, at least 18 years of age DOI: 10.1182/BLOOD.V130.SUPPL_1.1105.1105 Corpus ID: 57894142. Apixaban Is Safe and Effective in Morbidly Obese Patients: A Retrospective Analysis of 390 Patients with BMI ≥40 @article{Choi2017ApixabanIS, title={Apixaban Is Safe and Effective in Morbidly Obese Patients: A Retrospective Analysis of 390 Patients with BMI ≥40}, author={Yun-Jung Choi and M. Kushnir and H. Billett}, journal. The impact of morbid obesity on warfarin dosing has been well-described in the literature. 20,21 Mueller and colleagues showed a positive correlation between BMI and the total weekly dose of warfarin in a retrospective analysis of 831 patients with a BMI of 13.4 kg/m 2 to 63.1 kg/m 2. 20 They reported that for every 1-point increase in BMI, the.

(PDF) Comparative effectiveness and safety of direct oral

While bariatric surgical procedures have shown improvements in safety, the mitigation of venous thromboembolism (VTE) risk and iatrogenic events associated with anticoagulant chemoprophylaxis requires further investigation. Obesity is a significant risk factor for VTE development and the proposed mechanisms include increased inflammation [1], increased thrombin generation [2], and greater. c) Obese or morbidly obese (BMI ≥ 30 kg/m2) individuals: estimate a CrCl range using IBW and ABW that define the lower and upper boundaries (box 2). If the difference crosses over a DOAC dosing threshold, then assess bleeding and thrombosis risk to decide on suitable dos The Institute for Safe Medication Practices (ISMP) includes 19 categories of drugs in its list of high-alert medications.IHI's intervention focused on four categories — anticoagulants (which prevent blood from clotting), narcotics and opiates (used for pain management), insulin (which regulates blood glucose levels), and sedatives (which sedate patients prior to procedures or during their. Morbid obesity (consider radial access) Inability to lie supine for the duration of the procedure (patients with chronic back pain, heart failure, chronic obstructive pulmonary disease, etc.) Of note, none of the above are absolute contraindications for femoral access and the procedure can be performed using a small size catheter (4 or 5 Fr) Introduction. The direct oral anticoagulants (DOACs), including dabigatran and rivaroxaban, have been widely used for nonvalvular atrial fibrillation (NVAF) patients and are listed as the first choice for anticoagulation by the current guidelines. 1 DOACs, which are generally not necessary for regular monitoring the coagulation function, have a similar therapeutic effect to warfarin in.

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Thirdly, obese patients are at greater risk for failure in preventing VTE and obese patients are probably at greater risk for developing VTE. 6 Lastly, morbidly obese patients are becoming quite common as the population as a whole is becoming more obese. Even with this information, there are no standards of VTE prophylaxis in obese patients Choice of agent (completion rate: 100%). In conclusion, this survey clearly found that giving anticoagulation to severe obese patients during BS is consensual. However, significant discrepancies still exist in the management of perioperative thromboembolic risk in obese patients, reflecting the numerous knowledge gaps in preventing VTE. Anticoagulation with direct acting oral anticoagulants (DOACs) is recommended over warfarin for stroke prevention in patients with atrial fibrillation (AF). The efficacy of DOACs over warfarin in obese patients with AF is less defined and may carry the potential for sub therapeutic anticoagulation and reduced efficacy.The best available evidence to guide DOAC use in obese patients with AF is.

a Funnel plot to assess the publication bias for studies

1 Direct Oral Anticoagulant Choice for Stroke Prevention in Obese Patients with Atrial Fibrillation Tanveer Brar, BSc, BSc (Pharm), ACPR , PharmD 1 Doson Chua, BSc (Pharm), PharmD, FCSHP, BCPS, BCCP 1 1 3KDUPDF\'HSDUWPHQW 6W3DXO¶V+RVSLWDO Vancouver, BC Short title : Direct anticoagulant obese atrial fibrillatio These patients required additional anticoagulation after initial VTE treatment or finishing the DIVERSITY study. In this study, three (1.4%) patients experienced the recurrent clots. Use of DOACs in Obesity. Do: warfarin/ apixaban/ rivaroxaban . Don't: dabigatran. When treating obese patients (BMI > 30 kg/m - overweight / obese patients (i.e. greater than or equal to 105 kg), especially morbidly obese with body mass index (BMI) over 35 kg/m 2 o diseases of skeletal muscle (e.g. rhabdomyolysis) use of concomitant drugs that affect haemostasis (other anticoagulants, antiplatelet agents) recent surgery or traum **The choice anticoagulant for obese patients over 120kg should be discussed with the patient. If a NOAC appears the best choice for a patient, refer to haematology as anti-Xa level monitoring may be required. Does the patient have a contra-indication to a 4,5,6,7,16 - CrCl less than 15ml/minute - Known hypersensitivity - Pregnancy (any stage In the past decade obesity was declared an epidemic with the projection that by 2030, 58% of the world's population will be obese (1). Bariatric surgery remains one of the most effective methods for sustained weight loss among morbidly obese patients (2). Bariatric surgeries encompass procedures causin

Anticoagulation Clinic (only if patient has a PCP at UNMH, First Choice, First Nations, IHS or Healthcare for the Homeless) and arrange follow-up appointment OR arrange follow-up with outside PCP or Anticoagulation Clinic, optimally within 5-7 days of discharge vi The recommended total weight gain for obese women with BMI of ⩾ 30 kg m −2 is 11-20 lb (5 to 9 kg). Recent studies have suggested that women who are in the morbid and super obese categories.

In: El Solh AA, ed. Critical Care Management of the Obese Patient, first ed. John Wiley & Sons, Ltd.; 2012:13-20. Jones RL, Nzekwu M-MU. The effects of body mass index on lung volumes. Chest 2006;130:827-833. Schumann R. Pulmonary physiology of the morbidly obese and the effects of anesthesia. Int Anesthesiol Clin 2013;51:41-51. Pelosi P, et al Evaluation of therapeutic anticoagulation with enoxaparin and associated anti-Xa monitoring in patients with morbid obesity: a case series. J Thromb Thrombolysis 2011; 32 (02) 188-194 ; 47 Lalama JT, Feeney ME, Vandiver JW, Beavers KD, Walter LN, McClintic JR. Assessing an enoxaparin dosing protocol in morbidly obese patients. J Thromb.

Use of Direct Oral Anticoagulants in Morbidly Obese Patient

For patients at risk of bleeding, UFH is recommended instead of LMWH. UFH has a much shorter half-life than LMWH and its anticoagulant effect can be reversed rapidly and completely (as opposed to only partially reversed) with protamine (section 4.3.2). UFH may also be a better choice In a recent large prospective study on 3928 morbidly obese inpatients, high-dose thromboprophylaxis approximately halved the odds of symptomatic VTE, with no increased risk of bleeding . In conclusion, further studies regarding optimal doses for obese patients with anti-Xa factor measurements are still required. Several renal insufficienc Twenty-four patients (75.0%) were morbidly obese (BMI >30). None of the individuals in the control group C (sudden death) showed evidence of an acute or previous thromboembolic event at autopsy or on history review. Only 4 patients (12.5%) had a BMI greater than 30; all of these patients died a sudden cardiac death The World Health Organization reports worldwide obesity has tripled since 1975 with 40% of the population now considered obese. 1,2 It is estimated that 1 in 10 patients admitted to the hospital and 26% of critical care patients are Class 3, or extremely obese. 2-4 The critical care nurse is uniquely situated to assess the multifaceted needs of. Obesity has become an epidemic in the U.S. and throughout the world: currently, nearly 40% of Americans are considered obese. 24 Both dalteparin and enoxaparin are dosed according to body weight and dosing patients with morbid obesity can be challenging. Providers should be cautious with patients with extreme body weight, as these patients may be at an increased risk of medication accumulation.

In this episode I'll: 1. Review an article on monitoring enoxaparin with antifactor Xa levels in morbidly obese patients 2. Answer a drug information question about using morphine in a patient on dialysis 3. Share a great resource I use for researching which medications exacerbate porphyria Subscribe on iTunes, Android, or Stitcher Article Monitoring Enoxaparin Patient has risk factors for NOAC accumulation, such as creatinine clearance ≤80 mL/min with low body weight; Patient belongs to a group in which the use of NOACs has not been adequately studied, such as morbid obesity, weight <60 kg, or age ≥80 years; NOACs unavailable, not covered by the patient's insurance, or other cost concern pregnant patients. Low molecular weight heparin is the anticoagulation of choice during pregnancy because it does not cross the placenta; however it is unreliable in extreme obesity. Here we demonstrated the use of thrombolysis, heparin, and then warfarin when safe for the fetus, in a morbidly obese pregnant female with PE Low molecular weight heparin is the anticoagulation of choice during pregnancy because it does not cross the placenta; however it is unreliable in extreme obesity. Here we demonstrated the use of thrombolysis, heparin, and then warfarin when safe for the fetus, in a morbidly obese pregnant female with PE

Rivaroxaban Compared With Warfarin in Morbidly Obese

The proportion of patients defined as obese continues to grow in many westernized nations, particularly the United States (USA). This trend has shifted the perioperative management of obese patients into the realm of routine care. As obese patients present for all types of procedures, it is crucial for anesthesiologists, surgeons, internists, and perioperative health care providers alike to. anticoagulant effects as well as creatinine clearance should be considered in selected patients. Further clinical studies, particu-larly registries, are needed to determine whether a fixed dose of NOAC is truly efficacious in patients with morbid obesity. Anetta Undas Institute of Cardiology, Jagiellonian University Medical College, an This ARISTOPHANES analysis examined stroke/systemic embolism (SE) and major bleeding (MB) among a subgroup of nonvalvular atrial fibrillation (NVAF) patients with obesity prescribed warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) in order to inform clinical decision making. A retrospective observational study was conducted among NVAF patients who were obese and initiated. Morbidly obese patients receiving the recommended dose of enoxaparin 40 mg once daily were observed to have double the rate of VTE occurrence compared to non-obese patients 9. It is postulated that because patients with a higher BMI often have more fat than lean muscle tissue, the absorption of lipophilic drugs like UFH and LMWH is altered 9 thromboprophylaxis if possible for burn patients who have additional risk factors for VTE such as advanced age, morbid obesity, extensive burns or burns to the lower extremities, concomitant trauma to the lower extremities, use of a femoral venous catheter, and/or prolonged immobility (Grade 1C).

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Anticoagulation in the obese patient with COVID-19

Sara is a 65-year-old woman with long-standing type 2 diabetes mellitus (DM), hypertension, hyperlipidemia, and hypothyroidism. She is morbidly obese and has chronic kidney disease (CKD) with a glomerular filtration rate (GFR) of 65 ml/min/m 2. She complains of fatigue but has no chest pain. She is still able to do her activities of daily. are hospitalized for > 72 hours. Patients who qualify for immediate pharmacologic thromboprophylaxis upon admission include: all obese patients with a BMI ≥ 40kg/m2, and patients with significant underlying maternal prothrombotic medical issues (ex. lupus, sickle cell, heart disease) anticoagulants during pregnancy, however their use associated with increased immunological adverse reactions especially in obese pregnant women. Therefore, based on the present case report and its efficacy and tolerability, fondaparinux was the only non-heparin alternative anticoagulant option during pregnancy [9,10]. Safety of th Obesity is a global health problem whose prevalence is increasing. The World Health Organization (WHO) characterised obesity as a pandemic issue whose prevalence is higher in women than in men [].Consequently, the anaesthetist is increasingly confronted with the problems of anaesthetising obese patients, and even more so the obstetric anaesthetist

Patients who are known to have an underlying hypercoagulable state (e.g., those taking estrogen, pregnant women, or morbidly obese patients) should be informed of their risk of thrombosis. Patients should be counseled to avoid long periods of immobility (long trips) and to stretch often. The use of elastic compression stockings may be helpful The dose of enoxaparin does not need to be adjusted in the morbidly obese (BMI >35, or greater than 150kg), or those with a BMI 20 (underweight). These patients should be dosed on a mg/kg basis in the same way as patients of normal bodyweight, with adjustment for renal impairment if needed All morbidly obese patients undergoing caesarean section should be placed in a ramped position with left uterine displacement regardless of primary anaesthetic technique. Regional anaesthesia is the best possible choice in most cases of anticipated difficult airway. and an adequate dose of an anticoagulant for an appropriate duration is. of nonsurgical procedures in morbidly obese patients (e.g. for gastroscopy, transoesophageal echocardiography, or placement of intra-gastric bal-loon) one can only surmise that sedation with all sorts of benzodiazepines is commonly used in high-risk morbidly obese patients and considered well tolerated [10-12]

Perioperative anticoagulation Extended thromboprophylaxis Post-partum Intermediate risk in pregnancy Specialist prescribing only Sub-therapeutic INRs Transfer of prescribing to primary care in line with shared care protocol 3 day supply would be appropriate to be prescribed in the first instance VTE in patients with cance 2. Patients with a low risk thrombophilia and family (but no personal) history of VTE, should receive postpartum low dose anticoagulation but no anticoagulation antepartum II. Anticoagulation: Dosing and Monitoring General Principles: 1. Low molecular weight heparin (LMWH) is the preferred choice for prevention and treatment o nonadherence, and chronic anticoagulation Marginal Ulcers •Endoscopy is the diagnostic study of choice Marginal Ulcers •Dependent on its etiology -smokers, smoking cessation -proton pump inhibitors in the immediate postoperative period in morbidly obese patients In the morbid obesity group, PACU patients were more than those of the severe obesity and non-obesity groups. In this study, placement of epidural catheter in morbidly obese patients was technically challenging. There were more anesthesia puncture times in morbidly obese patients compared with the non-obesity group. Just as CS took an extended.