Practical considerations on non-vitamin K oral anticoagulants in patients with high body weight Reply

Under-representation of obese patients in the subgroups of relevant studies raises concerns about the efficacy and safety of new oral anticoagulants (NOACs). The number of patients with high body weights is quite low in studies investigating the phar macodynamics and pharmacokinetics of NOACs. In the context of data obtained from these studies, a fixed dose use of NOACs is recommended for obese or morbidly obese patients with no distinction from other patients. However, various recent case reports of pulmonary embolism or stroke under NOAC therapy have led to questions about the efficacy of fixed dose in this patient population. Increased creatinine clearance seems to be the most likely responsible mechanism. To overcome this problem, it is advisable to use drugs with less renal excretion in patients with increased creatinine clearance. Nevertheless, this hypoth esis needs to be confirmed with randomized studies