DOAC Therapy in Patients With Morbid Obesity After Intermediate or High Risk Pulmonary Emboli

Background There is little reported on the efficacy and safety of direct oral anticoagulants (DOAC) in morbid obesity after venous thromboembolism (VTE).

Methods This was an observational study of patients after intermediate- or high- risk pulmonary embolus (PE) who followed up in the University of Rochester Pulmonary Hypertension Clinic 2–4 months after the initial event with echocardiogram and V/Q imaging regardless of symptoms. Rates of recurrent VTE, thrombus resolution, and development of chronic thromboembolic pulmonary hypertension (CTEPH) in patients with morbid obesity treated with a DOAC compared to vitamin K antagonists and non-morbidly obese patient after PE. Using the electronic medical record, recurrent events were assessed out to 12 months.

Results 107 patients (32, BMI>40; 39, BMI 30–39.9; and 36, BMI<30) followed up after treatment for PE. A DOAC was used in 70 patients (19, BMI>40; 27, BMI 30–39.9; and 24, BMI<30). There were no recurrent events within the first 12 months of initial diagnosis based on symptoms and imaging in any patient. There was no difference in rate of residual unmatched perfusion defect with DOAC or conventional anticoagulation, 49% versus 49%. This finding remained in the subset of morbidly obese patients at 47% versus 50%. For the overall cohort, there was no difference in the rate of CTEPH development based on anticoagulation with DOAC having a rate of 5% (versus 8% with warfarin). There were no major bleeding complications with DOAC.

Conclusion DOAC therapy appears to be effective and safe in morbid obesity even after intermediate- or high- risk PE. ​