Category: Federal Forum Posters
Purpose: In 2016, the International Society on Thrombosis and Hemostasis (ISTH) released guidance recommending against the use of direct oral anticoagulants (DOACs) in patients with a body mass index (BMI) greater than 40 or weight greater than 120 kg. Evidence is slowly emerging showing DOACs, specifically apixaban and rivaroxaban, may be safe and effective in morbidly obese patients. Additionally, limited data may indicate apixaban is the preferred DOAC for use in treating morbidly obese patients. We set out to compare the safety and efficacy of apixaban vs rivaroxaban in morbidly obese patients in our large, level 1a medical facility.
Methods: An SQL query was created within the VA Puget Sound database which pulled prescription history for all DOACs dispensed between the dates of Oct 1, 2012 to July 30, 2018. Patient weight data was extracted as the last recorded weight prior to each prescribed DOAC release date. Patients with a last recorded weight greater than 120 kg prior to dispensing were included in the analysis. Patient age and eGFR data was extracted as the last recorded prior to each DOAC release date. Patients who received either rivaroxaban or apixaban, but not both were included in analysis. A total of 100 patients, 50 on rivaroxaban and 50 on apixaban, were matched 1 to 1 based on age and kidney function. A manual chart review will be conducted to assess and compare the frequency of thrombosis and bleeding events between groups. Demographic information gathered will include: age, weight, BMI, sex, eGFR, AC indication (AF, VTE), adherence, and length of therapy.
Results: not applicable
Conclusion: not applicable
Alice Knotts– Pharmacy Resident, VA Puget Sound, Seattle, WA