Abstract
Direct oral anticoagulants (DOACs) have become the standard of care for acute and long-term therapy for venous thromboembolism (VTE) due to their efficacy and safety profiles. The 2021 International Society on Thrombosis and Haemostasis guidelines recommend using standard DOAC dosages in patients with BMI >40 kg/m2 or weight >120 kg. Use of DOACs remains uncertain in morbidly obese patients with VTE, including acute PE. A morbidly obese woman in her 30s who presented with acute worsening of dyspnea was diagnosed with acute intermediate-high risk acute pulmonary embolism and concomitant proximal deep vein thrombosis, constituting a clinically challenging scenario for treating her with rivaroxaban. Standard doses of rivaroxaban for acute and extended phase treatment of venous thromboembolism in individuals with morbid obesity at BMI>70 kg/m2 may be effective, and safe.
Keywords:
direct oral anticoagulants; rivaroxaban; venous thromboembolism; morbid obesity; acute pulmonary embolism
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*Measurements were performed with Quest diagnostic laboratories modified chromogenic anti-Xa assays which compare the optical density of the patient’s sample to calibrated rivaroxaban controls, correlating directly to plasma rivaroxaban concentrations. Reference ranges: Rivaroxaban 20 mg daily dose {peak (182-408 mcg/L), trough (3-153 mcg/L)}; rivaroxaban 15 mg daily dose {peak (180 - 408 mcg/L), trough (2-161 mcg/L)}.