Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 359–365 | Cite as

Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review

  • Jared NetleyEmail author
  • Kris Howard
  • William Wilson



The International Society on Thrombosis and Haemostasis recommends avoiding the use of direct oral anticoagulants (DOACs) in patients with a body mass index (BMI) greater than 40 kg/m2 or weight greater than 120 kg.


Higher BMI is associated with altered pharmacokinetics which may affect the safety and effectiveness for DOACs.


Data were collected on 3458 patients taking a DOAC prior to admission to a Midwestern health system between February 2013 and August 2016. Of these, 43 patients had a thrombotic event and 70 patients had an overt bleeding event. Patients were stratified among the following three BMI groups: BMI < 30 kg/m2, BMI 30–40 kg/m2, and BMI > 40 kg/m2.


There was no statistically significant difference between BMI groups for thrombotic events (p = 0.598) or for overt bleeding events (p = 0.065). The BMI < 30 kg/m2 had the highest occurrence rate of bleeding events. It was observed that bleeding occurrence decreased as the BMI groups increased. The BMI > 40 kg/m2 group had the lowest risk of bleeding events, and was the only group to have a higher occurrence rate of thrombotic events compared to bleeding events.


Among patients admitted to a single health system on DOAC therapy over a three-and-a-half-year period, obesity did not significantly correlate with thrombotic or overt bleeding complications. This study is limited as a single health system study with low overall event rates. A preliminary finding of this study showed a trend towards decreased bleeding frequency as BMI increased.


Direct oral anticoagulants Pharmacology Body mass index Obesity 



Sarah Meeks for mentorship & Sarah Ferrell and Christopher Liston for aiding in data collection.


Dr. William Wilson is a member on the Eliquis® Advisory Board but accepts no financial contributions. No financial support or grants were used to fund this study. All funding was done by Parkview Health.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PharmacyParkview HealthFort WayneUSA
  2. 2.Department of CardiologyParkview HealthFort WayneUSA

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