Prevention of venous thromboembolism in obesity

Abstract

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized patients. Where appropriate, evidence-based methods of prophylaxis are implemented and the burden of VTE can be reduced substantially. Obesity, including morbid obesity, is associated with a high risk of VTE and, unfortunately, fixed doses of US FDA-approved anticoagulant regimens, including unfractionated heparins, low-molecular-weight heparins and factor Xa inhibitors, may not provide optimal VTE prophylaxis in these patients. Although the data are still limited, a rapidly growing body of literature and cumulative evidence suggests that anticoagulant dose adjustments in morbidly obese patients may optimize pharmacodynamic activity and reduce VTE risk. With the prevalence of morbid obesity continuing to rise, more high-quality clinical data are needed to better understand the pathobiology of VTE in obesity and provide effective, yet safe, prevention strategies.

Keywords::

• deep vein thrombosis
• fondaparinux
• low-molecular-weight heparin
• morbid obesity
• pulmonary embolism
• special populations
• venous thromboembolism prophylaxis

Acknowledgements

We would like to thank Kim Mahoney and Sharla Watts for their help and support in preparing this manuscript.

Financial & competing interests disclosure

This work was supported by the NIH (grant no. 1K23HL092161 and R43 HD066993). Robert C Pendleton is on the speaker’s bureau for Sanofi-Aventis and has received grant support from the NIH, ARUP Laboratories, Sanofi-Aventis, Boehringer Ingelheim, Pfizer, Canyon’s Pharmaceuticals and Bristol-Meyers Squibb. Matthew T Rondina is on the speaker’s bureau for Sanofi-Aventis and GSK and has received grant support from Sanofi-Aventis and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

PAI-1: Plasminogen activator inhibitor-1; TAFI: Thrombin-activatable fibrinolysis inhibitor; UL-vWF: Ultra-large von Willebrand factor.