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This clinical consensus statement updates a previous one published in 2018, by reviewing the most recent evidence on antithrombotic drugs based on body size categories according to the World Health Organization classification. The document focuses mostly on individuals at the extremes of body weight, i.e. underweight and moderate-to-morbid obesity, who require antithrombotic drugs, according to current guidelines, for the treatment or prevention of cardiovascular diseases or venous thromboembolism. Managing antithrombotic therapy or thromboprophylaxis in these individuals is challenging, due to profound changes<\/jats:p>\n                  <jats:p>in body composition, metabolism and organ function, and altered drug pharmacokinetics and pharmacodynamics, as well as weak or no evidence from clinical trials. The document also includes artificial intelligence simulations derived from in silico pharmacokinetic\/pharmacodynamic models, which can mimic the pharmacokinetic changes and help identify optimal regimens of antithrombotic drugs for severely underweight or severely obese individuals. Further, bariatric surgery in morbidly obese subjects is frequently performed worldwide. Bariatric surgery causes specific and additional changes in metabolism and gastrointestinal anatomy, depending on the type of the procedure, which can also impact the pharmacokinetics of antithrombotic drugs and their management. Based on existing literature, the document provides consensus statements on optimizing antithrombotic drug management for underweight and all classes of obese patients, while highlighting the current gaps in knowledge in these complex clinical settings, which require personalized medicine and precision pharmacology.<\/jats:p>","DOI":"10.1093\/ehjcvp\/pvae064","type":"journal-article","created":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T21:56:28Z","timestamp":1725573388000},"page":"614-645","source":"Crossref","is-referenced-by-count":34,"title":["Update on antithrombotic therapy and body mass: a clinical consensus statement of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and the European Society of Cardiology Working Group on Thrombosis"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4508-7990","authenticated-orcid":false,"given":"Bruna","family":"Gigante","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet , 17177 Stockholm ,","place":["Sweden"]},{"name":"Department of Cardiology, Danderyds Hospital , 18288 Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7979-7758","authenticated-orcid":false,"given":"Juan","family":"Tamargo","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, de Madrid, Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n, CIBERCV , 28040 Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6942-6312","authenticated-orcid":false,"given":"Stefan","family":"Agewall","sequence":"additional","affiliation":[{"name":"Division of Clinical Science, Danderyds Hospital, Karolinska Institutet, \u00a0 18288 Stockholm ,","place":["Sweden"]},{"name":"Institute of Clinical Sciences, University of Oslo , NO-0318 Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1513-8793","authenticated-orcid":false,"given":"Dan","family":"Atar","sequence":"additional","affiliation":[{"name":"Institute of Clinical Sciences, University of Oslo , NO-0318 Oslo ,","place":["Norway"]},{"name":"Department of Cardiology, Oslo University Hospital Ulleval, N-0450 Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jurrien","family":"ten Berg","sequence":"additional","affiliation":[{"name":"St Antonius Hospital , Koekoekslaan 1, 3435 CM Nieuwegein ,","place":["the Netherlands"]},{"name":"Maastricht University Medical Center , P Debyelaan 25, 6229 HX Maastricht, \u00a0","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-188X","authenticated-orcid":false,"given":"Gianluca","family":"Campo","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Cona, FE 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7839-1361","authenticated-orcid":false,"given":"Elisabetta","family":"Cerbai","sequence":"additional","affiliation":[{"name":"Department of Neurofarba, University of Florence, Viale G. 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