{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:25:46Z","timestamp":1793395546644,"version":"4.5.0"},"reference-count":130,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:00:00Z","timestamp":1734393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Obesity is a recognized risk factor for venous thromboembolism (VTE), associated with distinct challenges in managing anticoagulation therapy. There is still limited evidence regarding the impact of extreme body weight on the pharmacokinetics, pharmacodynamics, efficacy, and safety of various anticoagulant medications. To our knowledge, this is the first comprehensive review to address both prophylactic and therapeutic anticoagulant dosages specifically for managing VTE in patients with a body mass index (BMI) \u226540\u00a0kg\/m<jats:sup>2<\/jats:sup> or weight \u2265120\u00a0kg. Our aim was to synthesize the findings of relevant studies alongside the latest recommendations on anticoagulation in this unique population. We gathered and analyzed data on all classes of anticoagulants available for VTE management, including vitamin K antagonists (VKAs), unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, and direct oral anticoagulants (DOACs), offering insights into their efficacy and safety profiles. Additionally, we explored special subpopulations of morbidly obese patients, such as those with cancer, renal dysfunction, or those undergoing bariatric surgery, recognizing the nuanced therapeutic challenges they present. The current evidence for anticoagulant therapy in morbidly obese patients with VTE is evidently insufficient, underscoring the need for a tailored approach and meticulous monitoring to achieve an optimal therapeutic balance.<\/jats:p>","DOI":"10.3389\/fphar.2024.1457280","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T06:23:25Z","timestamp":1734416605000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Anticoagulation approach in morbid obesity: a comprehensive review on venous thromboembolism management"],"prefix":"10.3389","volume":"15","author":[{"given":"Victorita","family":"Sorodoc","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Asaftei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandr","family":"Ceasovschih","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalina","family":"Lionte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simina","family":"Crisan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Constantin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Indrei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurentiu","family":"Sorodoc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"380","DOI":"10.3390\/cancers10100380","article-title":"Cancer-associated thrombosis: an overview of mechanisms, risk factors, and treatment","volume":"10","author":"Abdol Razak","year":"2018","journal-title":"Cancers"},{"key":"B2","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1056\/nejmoa1302507","article-title":"Oral apixaban for the treatment of acute venous thromboembolism","volume":"369","author":"Agnelli","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"191","DOI":"10.4314\/tjpr.v20i1.27","article-title":"Utilization of adjusted body weight for dosing unfractionated heparin in obese patients with venous thromboembolism: a retrospective matched cohort study","volume":"20","author":"Alessa","year":"2021","journal-title":"Trop. J. Pharm. Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e11047","DOI":"10.7759\/cureus.11047","article-title":"Warfarin dosing requirement according to body mass index","volume":"12","author":"Alshammari","year":"2020","journal-title":"Cureus"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1163684","DOI":"10.3389\/fcvm.2023.1163684","article-title":"Effectiveness, safety, and costs of thromboprophylaxis with enoxaparin or unfractionated heparin in inpatients with obesity","volume":"10","author":"Amin","year":"2023","journal-title":"Front. Cardiovasc. Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1002\/ajh.25494","article-title":"Bleeding incidence and risk factors among cancer patients treated with anticoagulation","volume":"94","author":"Angelini","year":"2019","journal-title":"Am. J. Hematol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1111\/ejh.13817","article-title":"Safety and efficacy of apixaban and rivaroxaban in obese patients with acute venous thrombosis\/embolism","volume":"109","author":"Anusim","year":"2022","journal-title":"Eur. J. Haematol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"105S","DOI":"10.1038\/oby.2002.203","article-title":"Classification of obesity and assessment of obesity-related health risks","volume":"10","author":"Aronne","year":"2002","journal-title":"Obes. Res."},{"key":"B9","unstructured":"Deep venous thrombosis (DVT) prophylaxis\n          \n          \n            \n              Badireddy\n              M.\n            \n            \n              Mudipalli\n              V. R.\n            \n          \n          \n          2020"},{"key":"B10","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/j.soard.2008.03.005","article-title":"Limitations of a standardized weight-based nomogram for heparin dosing in patients with morbid obesity","volume":"4","author":"Barletta","year":"2008","journal-title":"Surg. Obes. Relat. Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"10742484221145010","DOI":"10.1177\/10742484221145010","article-title":"Fondaparinux sodium: recent advances in the management of thrombosis","volume":"28","author":"Bauersachs","year":"2023","journal-title":"J. Cardiovasc. Pharmacol. Ther."},{"key":"B12","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1007\/s11239-022-02661-1","article-title":"Effectiveness, safety, and healthcare costs associated with rivaroxaban versus warfarin among venous thromboembolism patients with obesity: a real-world study in the United States","volume":"54","author":"Berger","year":"2022","journal-title":"J. Thromb. Thrombolysis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1177\/08971900211022300","article-title":"Evaluation of a treatment-dose enoxaparin protocol for patients with obesity","volume":"36","author":"Berger","year":"2021","journal-title":"J. Pharm. Pract."},{"key":"B14","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1055\/s-0037-1613961","article-title":"Nomograms for the administration of unfractionated heparin in the initial treatment of acute thromboembolism \u2013 an overview","volume":"84","author":"Bernardi","year":"2000","journal-title":"Thromb. Haemost."},{"key":"B15","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1097\/moh.0b013e3283634443","article-title":"Mechanisms of thrombosis in obesity","volume":"20","author":"Blokhin","year":"2013","journal-title":"Curr. Opin. Hematol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1038\/s41574-019-0176-8","article-title":"Obesity: global epidemiology and pathogenesis","volume":"15","author":"Bl\u00fcher","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"155217","DOI":"10.1016\/j.metabol.2022.155217","article-title":"A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on","volume":"133","author":"Boutari","year":"2022","journal-title":"Metabol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.jtha.2022.11.012","article-title":"Adipokines and incident venous thromboembolism: the multi-ethnic study of atherosclerosis","volume":"21","author":"Broni","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"B19","doi-asserted-by":"publisher","first-page":"5434","DOI":"10.3390\/curroncol28060453","article-title":"Treatment algorithm in cancer-associated thrombosis: updated Canadian expert consensus","volume":"28","author":"Carrier","year":"2021","journal-title":"Curr. Oncol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1160\/th13-06-0443","article-title":"Vitamin K antagonists in heart disease: current status and perspectives (section III). Position paper of the ESC working group on thrombosis--task force on anticoagulants in heart disease","volume":"110","author":"Caterina","year":"2013","journal-title":"Thromb. Haemost."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.3390\/biomedicines11051290","article-title":"The role of adipokines in health and disease","volume":"11","author":"Clemente-Su\u00e1rez","year":"2023","journal-title":"Biomedicines"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3003","DOI":"10.1007\/s12325-021-01716-8","article-title":"Efficacy, safety, and exposure of apixaban in patients with high body weight or obesity and venous thromboembolism: insights from AMPLIFY","volume":"38","author":"Cohen","year":"2021","journal-title":"Adv. Ther."},{"key":"B23","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1038\/clpt.2011.309","article-title":"Pharmacokinetic and pharmacodynamic variability of fluindione in octogenarians","volume":"91","author":"Comets","year":"2012","journal-title":"Clin. Pharmacol. Ther."},{"key":"B24","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s11239-020-02199-0","article-title":"Effectiveness and safety of rivaroxaban versus warfarin in obese patients with acute venous thromboembolism: analysis of electronic health record data","volume":"51","author":"Costa","year":"2020","journal-title":"J. Thromb. Thrombolysis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1002\/phar.2655","article-title":"Multi\u2010center retrospective study evaluating the efficacy and safety of apixaban versus warfarin for treatment of venous thromboembolism in patients with severe obesity","volume":"42","author":"Crouch","year":"2021","journal-title":"Pharmacotherapy"},{"key":"B26","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1001\/archinte.1991.00400020085018","article-title":"A standard heparin nomogram for the management of heparin therapy","volume":"151","author":"Cruickshank","year":"1991","journal-title":"Arch. Intern. Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1177\/1060028018821149","article-title":"Evaluation of treatment-dose enoxaparin in acutely ill morbidly obese patients at an academic medical center: a randomized clinical trial","volume":"53","author":"Curry","year":"2018","journal-title":"Ann. Pharmacother."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1111\/j.1538-7836.2007.02565.x","article-title":"Effect of obesity on outcomes after fondaparinux, enoxaparin, or heparin treatment for acute venous thromboembolism in the Matisse trials","volume":"5","author":"Davidson","year":"2007","journal-title":"J. Thromb. Haemost."},{"key":"B29","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1007\/s11239-011-0584-7","article-title":"Evaluation of therapeutic anticoagulation with enoxaparin and associated anti-Xa monitoring in patients with morbid obesity: a case series","volume":"32","author":"Deal","year":"2011","journal-title":"J. Thromb. Thrombolysis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"642","DOI":"10.2146\/ajhp080200","article-title":"Estimation of creatinine clearance in morbidly obese patients","volume":"66","author":"Demirovic","year":"2009","journal-title":"Am. J. Health. Syst. Pharm."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.7754\/Clin.Lab.2019.181119","article-title":"Resistin promotes thrombosis in rats with deep vein thrombosis via up-regulating MMP-2, MMP-9, and PAI-1","volume":"65","author":"Ding","year":"2019","journal-title":"Clin. Lab."},{"key":"B32","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1159\/000526115","article-title":"Should the CKD EPI equation Be used for estimation of the glomerular filtration rate in obese subjects?","volume":"47","author":"Domislovic","year":"2022","journal-title":"Kidney. blood. Press. Res."},{"key":"B33","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/j.annonc.2022.12.014","article-title":"Venous thromboembolism in cancer patients: ESMO clinical practice guideline","volume":"34","author":"Falanga","year":"2023","journal-title":"Ann. Oncol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.2146\/ajhp150388","article-title":"Evaluation of heparin dosing based on adjusted body weight in obese patients","volume":"73","author":"Fan","year":"2016","journal-title":"Am. J. Health. Syst. Pharm."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.3390\/nu15051233","article-title":"Estimation of glomerular filtration rate in obese patients: utility of a new equation","volume":"15","author":"Fern\u00e1ndez","year":"2023","journal-title":"Nutrients"},{"key":"B36","first-page":"75","article-title":"Methods of estimating GFR - different equations including CKD-EPI","volume":"32","author":"Florkowski","year":"2011","journal-title":"Clin. Biochem. Rev."},{"key":"B37","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1002\/ajh.23228","article-title":"Prospective comparison of three enoxaparin dosing regimens to achieve target anti-factor Xa levels in hospitalized, medically ill patients with extreme obesity","volume":"87","author":"Freeman","year":"2012","journal-title":"Am. J. Hematol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1111\/jth.15701","article-title":"Elevated plasma levels of plasminogen activator inhibitor\u20101 are associated with risk of future incident venous thromboembolism","volume":"20","author":"Frischmuth","year":"2022","journal-title":"J. Thromb. Haemost."},{"key":"B39","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12902-019-0386-z","article-title":"Total adiponectin in overweight and obese subjects and its response to visceral fat loss","volume":"19","author":"Gariballa","year":"2019","journal-title":"BMC Endocr. Disord."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1016\/j.soard.2017.07.027","article-title":"Anti-factor Xa levels in patients undergoing laparoscopic sleeve gastrectomy: 2 different dosing regimens of enoxaparin","volume":"13","author":"Gelikas","year":"2017","journal-title":"Surg. Obes. Relat. Dis."},{"key":"B41","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1007\/s11096-020-01004-5","article-title":"Unfractionated heparin dosing in obese patients","volume":"42","author":"George","year":"2020","journal-title":"Int. J. Clin. Pharm."},{"key":"B42","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40360-023-00643-4","article-title":"Novel fondaparinux protocol for anticoagulation therapy in adults with renal failure and suspected heparin-induced thrombocytopenia: a retrospective review of institutional protocol","volume":"24","author":"Ghaziri","year":"2023","journal-title":"BMC Pharmacol. Toxicol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s11239-020-02360-9","article-title":"Comparison of two escalated enoxaparin dosing regimens for venous thromboembolism prophylaxis in obese hospitalized patients","volume":"52","author":"Gibson","year":"2021","journal-title":"J. Thromb. Thrombolysis."},{"key":"B44","doi-asserted-by":"publisher","first-page":"115281","DOI":"10.1016\/j.biopha.2023.115281","article-title":"Pharmacokinetics of obese adults: not only an increase in weight","volume":"166","author":"Gouju","year":"2023","journal-title":"Biomed. Pharmacother."},{"key":"B45","doi-asserted-by":"publisher","first-page":"e072715","DOI":"10.1136\/bmj-2022-072715","article-title":"Prevention of venous thromboembolism in patients with cancer","volume":"381","author":"Guntupalli","year":"2023","journal-title":"BMJ"},{"key":"B46","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1177\/0018578718802839","article-title":"Therapeutic enoxaparin in the morbidly obese patient: a case report and review of the literature","volume":"54","author":"Hanni","year":"2018","journal-title":"Hosp. Pharm."},{"key":"B47","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.1016\/j.arth.2020.06.032","article-title":"A prospective cohort comparative study of rivaroxaban, dabigatran, and apixaban oral thromboprophylaxis in 2431 hip and knee arthroplasty patients: primary efficacy outcomes and safety profile","volume":"35","author":"Highcock","year":"2020","journal-title":"J. Arthroplasty."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2317","DOI":"10.1001\/archinte.157.20.2317","article-title":"The importance of initial heparin treatment on long-term clinical outcomes of antithrombotic therapy. The emerging theme of delayed recurrence","volume":"157","author":"Hull","year":"1997","journal-title":"Arch. Intern. Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1038\/s41574-019-0260-0","article-title":"The clinical potential of circulating microRNAs in obesity","volume":"15","author":"Ji","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1159\/000354218","article-title":"Vitamin K intake, body mass index and warfarin maintenance dose","volume":"126","author":"Kabagambe","year":"2013","journal-title":"Cardiol"},{"key":"B51","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.chest.2015.11.026","article-title":"Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report","volume":"149","author":"Kearon","year":"2016","journal-title":"Chest"},{"key":"B52","doi-asserted-by":"publisher","first-page":"3063","DOI":"10.1200\/jco.23.00294","article-title":"Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update","volume":"41","author":"Key","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"B53","doi-asserted-by":"publisher","first-page":"e20230056","DOI":"10.1590\/1677-5449.202300562","article-title":"Successful use of rivaroxaban achieving therapeutic anti-factor xa levels in a morbidly obese patient with acute intermediate-high risk pulmonary embolism","volume":"22","author":"Kingsley","year":"2023","journal-title":"J. Vasc. Bras."},{"key":"B54","doi-asserted-by":"publisher","first-page":"14982","DOI":"10.3390\/ijms232314982","article-title":"The role of adipokines in inflammatory mechanisms of obesity","volume":"23","author":"Kirichenko","year":"2022","journal-title":"Int. J. Mol. Sci."},{"key":"B55","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1160\/th11-09-0611","article-title":"Infections and inflammatory diseases as risk factors for venous thrombosis. A systematic review","volume":"107","author":"Kluin-Nelemans","year":"2012","journal-title":"Thromb. Haemost."},{"key":"B56","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2019","journal-title":"Eur. Heart. J."},{"key":"B57","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.ejim.2023.04.032","article-title":"Renal hyperfiltration revisited\u2014role of the individual body surface area on mortality","volume":"114","author":"Korhonen","year":"2023","journal-title":"Eur. J. Intern. Med."},{"key":"B58","doi-asserted-by":"publisher","first-page":"e2315241","DOI":"10.1001\/jamanetworkopen.2023.15241","article-title":"Efficacy and safety of rivaroxaban for postoperative thromboprophylaxis in patients after bariatric surgery: a randomized clinical trial","volume":"6","author":"Kr\u00f6ll","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"B59","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3121\/cmr.2009.866","article-title":"Virchow\u2019s contribution to the understanding of thrombosis and cellular biology","volume":"8","author":"Kumar","year":"2010","journal-title":"Clin. Med. Res."},{"key":"B60","doi-asserted-by":"publisher","first-page":"e359","DOI":"10.1016\/s2352-3026(19)30086-9","article-title":"Efficacy and safety of direct oral factor Xa inhibitors compared with warfarin in patients with morbid obesity: a single-centre, retrospective analysis of chart data","volume":"6","author":"Kushnir","year":"2019","journal-title":"Lancet. Haematol."},{"key":"B61","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1007\/s11239-014-1117-y","article-title":"Assessing an enoxaparin dosing protocol in morbidly obese patients","volume":"39","author":"Lalama","year":"2014","journal-title":"J. Thromb. Thrombolysis."},{"key":"B62","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.cca.2013.02.003","article-title":"Adipokines in obesity","volume":"419","author":"Leal","year":"2013","journal-title":"Clin. Chim. Acta."},{"key":"B63","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1007\/s11239-017-1535-8","article-title":"Efficacy of standard dose unfractionated heparin for venous thromboembolism prophylaxis in morbidly obese and non-morbidly obese critically Ill patients","volume":"44","author":"Lee","year":"2017","journal-title":"J. Thromb. Thrombolysis"},{"key":"B64","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s40261-019-00855-9","article-title":"Stratifying therapeutic enoxaparin dose in morbidly obese patients by BMI class: a retrospective cohort study","volume":"40","author":"Lee","year":"2019","journal-title":"Clin. Drug Investig."},{"key":"B65","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1002\/phar.1658","article-title":"Monitoring enoxaparin with antifactor xa levels in obese patients","volume":"35","author":"Lee","year":"2015","journal-title":"Pharmacotherapy"},{"key":"B66","doi-asserted-by":"publisher","first-page":"1988","DOI":"10.1111\/jth.15823","article-title":"Direct oral anticoagulants after bariatric surgery\u2014what is the evidence?","volume":"20","author":"Leong","year":"2022","journal-title":"J. Thromb. Haemost."},{"key":"B67","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/fcp.12587","article-title":"Impact of bariatric surgery on oral anticoagulants pharmacology, and consequences for clinical practice: a narrative review","volume":"35","author":"Leven","year":"2020","journal-title":"Fundam. Clin. Pharmacol."},{"key":"B68","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1038\/s41581-019-0191-y","article-title":"Measured and estimated glomerular filtration rate: current status and future directions","volume":"16","author":"Levey","year":"2019","journal-title":"Nat. Rev. Nephrol."},{"key":"B69","doi-asserted-by":"publisher","first-page":"1084511","DOI":"10.3389\/fendo.2023.1084511","article-title":"Strategies involving low-molecular-weight heparin for the treatment and prevention of venous thromboembolism in patients with obesity: a systematic review and meta-analysis","volume":"14","author":"Liu","year":"2023","journal-title":"Front. Endocrinol."},{"key":"B70","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1038\/s41366-019-0476-z","article-title":"The estimation of GFR and the adjustment for BSA in overweight and obesity: a dreadful combination of two errors","volume":"44","author":"L\u00f3pez-Mart\u00ednez","year":"2019","journal-title":"Int. J. Obes."},{"key":"B71","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1182\/bloodadvances.2020003442","article-title":"American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer","volume":"5","author":"Lyman","year":"2021","journal-title":"Blood. Adv."},{"key":"B72","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12959-023-00576-2","article-title":"Efficacy and safety of anticoagulant for treatment and prophylaxis of VTE patients with renal insufficiency: a systemic review and meta-analysis","volume":"22","author":"Ma","year":"2024","journal-title":"Thromb. J."},{"key":"B73","doi-asserted-by":"publisher","first-page":"e0214134","DOI":"10.1371\/journal.pone.0214134","article-title":"Extended anticoagulation for the secondary prevention of venous thromboembolic events: an updated network meta-analysis","volume":"14","author":"Mai","year":"2019","journal-title":"PLoS One"},{"key":"B74","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1111\/jth.13323","article-title":"Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH","volume":"14","author":"Martin","year":"2016","journal-title":"J. Thromb. Haemost."},{"key":"B75","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1007\/s11239-023-02774-1","article-title":"DOAC compared with warfarin for VTE in patients with obesity: a retrospective cohort study conducted through the VENUS network","volume":"55","author":"Martin","year":"2023","journal-title":"J. Thromb. Thrombolysis."},{"key":"B76","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1111\/jth.15358","article-title":"Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: updated communication from the ISTH SSC Subcommittee on Control of Anticoagulation","volume":"19","author":"Martin","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"B77","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.amjmed.2016.12.033","article-title":"Oral anticoagulant use after bariatric surgery: a literature review and clinical guidance","volume":"130","author":"Martin","year":"2017","journal-title":"Am. J. Med."},{"key":"B78","doi-asserted-by":"publisher","first-page":"1716","DOI":"10.2146\/ajhp110010","article-title":"Effect of fondaparinux prophylaxis on anti-factor Xa concentrations in patients with morbid obesity","volume":"68","author":"Martinez","year":"2011","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"B79","doi-asserted-by":"publisher","first-page":"e249","DOI":"10.1016\/j.amjmed.2019.12.003","article-title":"Safety and efficacy of high-dose unfractionated heparin versus high-dose enoxaparin for venous thromboembolism prevention in morbidly obese hospitalized patients","volume":"133","author":"Mason","year":"2020","journal-title":"Am. J. Med."},{"key":"B80","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1002\/phar.2161","article-title":"Relationship between international normalized ratio and outcomes in modern trials with warfarin controls","volume":"38","author":"McDowell","year":"2018","journal-title":"Pharmacotherapy"},{"key":"B81","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1177\/1060028013517541","article-title":"Warfarin dosing and body mass index","volume":"48","author":"Mueller","year":"2014","journal-title":"Ann. Pharmacother."},{"key":"B82","doi-asserted-by":"publisher","first-page":"84","DOI":"10.22265\/acnef.6.2.353","article-title":"Como evaluar el filtrado glomerular en el paciente obeso","volume":"6","author":"Musso","year":"2019","journal-title":"Rev. Colomb. Nefrol."},{"key":"B83","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1586\/erc.09.19","article-title":"Fondaparinux: an overview","volume":"7","author":"Nadar","year":"2009","journal-title":"Expert Rev. cardiovasc. Ther."},{"key":"B84","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/osp4.629","article-title":"Obesity and chronic kidney disease: a current review","volume":"9","author":"Nawaz","year":"2022","journal-title":"Obes. Sci. Pract."},{"key":"B85","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.3390\/medicina58091290","article-title":"Obesity as a risk factor for venous thromboembolism recurrence: a systematic review","volume":"58","author":"Ntinopoulou","year":"2022","journal-title":"Medicina"},{"key":"B86","doi-asserted-by":"publisher","DOI":"10.1161\/atvb.35.suppl_1.388","article-title":"Abstract 388: body mass index predicts major leeding risks in patients on warfarin","volume":"35","author":"Ogunsua","year":"2015","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"B87","doi-asserted-by":"publisher","first-page":"4693","DOI":"10.1182\/bloodadvances.2020001830","article-title":"American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism","volume":"4","author":"Ortel","year":"2020","journal-title":"Blood Adv."},{"key":"B88","doi-asserted-by":"publisher","first-page":"3169","DOI":"10.3390\/ijms24043169","article-title":"A comprehensive review of risk factors for venous thromboembolism: from epidemiology to pathophysiology","volume":"24","author":"Pastori","year":"2023","journal-title":"Int. J. Mol. Sci."},{"key":"B89","doi-asserted-by":"publisher","first-page":"11","DOI":"10.4103\/ijmr.ijmr_1768_17","article-title":"Obesity subtypes, related biomarkers and heterogeneity","volume":"151","author":"Perez-Campos","year":"2020","journal-title":"Indian. J. Med. Res."},{"key":"B90","doi-asserted-by":"publisher","first-page":"e008005","DOI":"10.1161\/circoutcomes.121.008005","article-title":"Anticoagulation treatment and outcomes of venous thromboembolism by weight and body mass index: insights from the veterans health administration","volume":"14","author":"Perino","year":"2021","journal-title":"Circ. Cardiovasc. Qual. Outcomes."},{"key":"B91","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1378\/chest.10-3084","article-title":"Dosing frequency of unfractionated heparin thromboprophylaxis: a meta-analysis","volume":"140","author":"Phung","year":"2011","journal-title":"Chest"},{"key":"B92","doi-asserted-by":"publisher","first-page":"874","DOI":"10.7326\/0003-4819-119-9-199311010-00002","article-title":"The weight-based heparin dosing nomogram compared with a \u201cstandard care\u201d nomogram. A randomized controlled trial","volume":"119","author":"Raschke","year":"1993","journal-title":"Ann. Intern. Med."},{"key":"B93","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1177\/1060028020974569","article-title":"Safety of high-dose unfractionated heparin for prophylaxis of venous thromboembolism in hospitalized obese patients","volume":"55","author":"Regis","year":"2020","journal-title":"Ann. Pharmacother."},{"key":"B94","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1345\/aph.1p088","article-title":"Identifying optimal initial infusion rates for unfractionated heparin in morbidly obese patients","volume":"44","author":"Riney","year":"2010","journal-title":"Ann. Pharmacother."},{"key":"B95","doi-asserted-by":"publisher","first-page":"1672","DOI":"10.1093\/eurheartj\/ehy066","article-title":"Antithrombotic therapy and body mass: an expert position paper of the ESC Working Group on Thrombosis","volume":"39","author":"Rocca","year":"2018","journal-title":"Eur. Heart. J."},{"key":"B96","doi-asserted-by":"publisher","first-page":"E691","DOI":"10.1152\/ajpendo.00297.2015","article-title":"Revisiting the adipocyte: a model for integration of cytokine signaling in the regulation of energy metabolism","volume":"309","author":"Rodr\u00edguez","year":"2015","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"B97","doi-asserted-by":"publisher","first-page":"678159","DOI":"10.1155\/2013\/678159","article-title":"Obesity and inflammation: epidemiology, risk factors, and markers of inflammation","volume":"2013","author":"Rodr\u00edguez-Hern\u00e1ndez","year":"2013","journal-title":"Int. J. Endocrinol."},{"key":"B98","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/j.amjmed.2023.01.010","article-title":"Direct oral anticoagulants in obese patients with venous thromboembolism: results of an expert consensus panel","volume":"136","author":"Rosovsky","year":"2023","journal-title":"Am. J. Med."},{"key":"B99","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/5584_2016_101","article-title":"Thromboembolic prophylaxis for morbidly obese patients undergoing bariatric surgery","volume":"906","author":"Ruiz-Tovar","year":"2017","journal-title":"Adv. Exp. Med. Biol."},{"key":"B100","doi-asserted-by":"publisher","first-page":"3675","DOI":"10.1182\/blood-2019-121765","article-title":"Efficacy and safety of direct oral anticoagulants in obese patients with venous thromboembolism","volume":"134","author":"Sa","year":"2019","journal-title":"Blood"},{"key":"B101","doi-asserted-by":"publisher","first-page":"00379","DOI":"10.1183\/23120541.00379-2021","article-title":"Use of direct oral anticoagulants for acute pulmonary embolisms in obesity: a propensity-matched, multicentre case\u2013control study","volume":"7","author":"Samaranayake","year":"2021","journal-title":"ERJ. Open. Res."},{"key":"B102","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1002\/jha2.418","article-title":"Comparing direct oral anticoagulants and vitamin K antagonist use in morbidly obese patients with venous thromboembolism: a single center retrospective cohort study","volume":"3","author":"Scott","year":"2022","journal-title":"EJHaem"},{"key":"B103","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/mbc.0000000000000336","article-title":"Safety and efficacy of the use of institutional unfractionated heparin protocols for therapeutic anticoagulation in obese patients: a retrospective chart review","volume":"26","author":"Shin","year":"2015","journal-title":"Blood. Coagul. Fibrinolysis."},{"key":"B104","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1177\/1358863x19875813","article-title":"Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping","volume":"25","author":"Shlensky","year":"2019","journal-title":"Vasc. Med."},{"key":"B105","doi-asserted-by":"publisher","first-page":"2392","DOI":"10.1007\/s00464-008-9997-6","article-title":"Comparison of two low-molecular-weight heparin dosing regimens for patients undergoing laparoscopic bariatric surgery","volume":"22","author":"Simone","year":"2008","journal-title":"Surg. Endosc."},{"key":"B106","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1038\/sj.ijo.0802778","article-title":"Obesity and impaired fibrinolysis: role of adipose production of plasminogen activator inhibitor-1","volume":"28","author":"Skurk","year":"2004","journal-title":"Int. J. Obes. Relat. Metab."},{"key":"B107","doi-asserted-by":"publisher","first-page":"17539447211012803","DOI":"10.1177\/17539447211012803","article-title":"Impact of body mass index on 90-day warfarin requirements: a retrospective chart review","volume":"15","author":"Soyombo","year":"2021","journal-title":"Ther. Adv. Cardiovasc. Dis."},{"key":"B108","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s11239-024-02955-6","article-title":"Retrospective, multicenter analysis of the safety and effectiveness of direct oral anticoagulants for the treatment of venous thromboembolism in obesity","volume":"57","author":"Sperry","year":"2024","journal-title":"J. Thromb. Thrombolysis."},{"key":"B109","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.thromres.2019.08.021","article-title":"Rivaroxaban versus warfarin treatment among morbidly obese patients with venous thromboembolism: comparative effectiveness, safety, and costs","volume":"182","author":"Spyropoulos","year":"2019","journal-title":"Thromb. Res."},{"key":"B110","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.soard.2015.08.505","article-title":"Once versus twice daily injection of enoxaparin for thromboprophylaxis in bariatric surgery: effects on antifactor Xa activity and procoagulant microparticles. A randomized controlled study","volume":"12","author":"Steib","year":"2016","journal-title":"Surg. Obes. Relat. Dis."},{"key":"B111","doi-asserted-by":"publisher","first-page":"e545","DOI":"10.1016\/j.chest.2021.07.055","article-title":"Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report","volume":"160","author":"Stevens","year":"2021","journal-title":"Chest"},{"key":"B112","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11695-022-06051-7","article-title":"The safety and efficacy of apixaban (eliquis) in 5017 post-bariatric patients with 95.3% follow-up: a multicenter study","volume":"32","author":"Surve","year":"2022","journal-title":"Obes. Surg."},{"key":"B113","first-page":"476","article-title":"Warfarin--indications, risks and drug interactions","volume":"39","author":"Tadros","year":"2010","journal-title":"Aust. Fam. Physician."},{"key":"B114","doi-asserted-by":"publisher","first-page":"e31","DOI":"10.1055\/s-0043-1776989","article-title":"Direct-Acting Oral Anticoagulants in patients at extremes of body weight: a review of pharmacological considerations and clinical implications","volume":"8","author":"Talerico","year":"2024","journal-title":"Th. Open"},{"key":"B115","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1177\/1753944718781295","article-title":"Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients","volume":"12","author":"Tellor","year":"2018","journal-title":"Ther. Adv. Cardiovasc. Dis."},{"key":"B116","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1177\/1076029614568713","article-title":"Evaluation and pharmacokinetics of treatment dose enoxaparin in hospitalized patients with morbid obesity","volume":"21","author":"Thompson-Moore","year":"2015","journal-title":"Clin. Appl. Thromb. Hemost."},{"key":"B117","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/j.mcna.2010.03.003","article-title":"The complex clinical picture of side effects to anticoagulation","volume":"94","author":"Trautmann","year":"2010","journal-title":"Med. Clin. North Am."},{"key":"B118","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1007\/s11239-015-1231-5","article-title":"Chemical prophylaxis to prevent venous thromboembolism in morbid obesity: literature review and dosing recommendations","volume":"41","author":"Vandiver","year":"2015","journal-title":"J. Thromb. Thrombolysis"},{"key":"B119","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1093\/cvr\/cvx086","article-title":"New insights into the role of adipose tissue in thrombosis","volume":"113","author":"Vilahur","year":"2017","journal-title":"Cardiovasc. Res."},{"key":"B120","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1007\/s11239-012-0811-x","article-title":"Comparison of initial warfarin response in obese patients versus non-obese patients","volume":"36","author":"Wallace","year":"2013","journal-title":"J. Thromb. Thrombolysis."},{"key":"B121","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.3389\/fphar.2018.01087","article-title":"PAI-1 exacerbates white adipose tissue dysfunction and metabolic dysregulation in high fat diet-induced obesity","volume":"9","author":"Wang","year":"2018","journal-title":"Front. Pharmacol."},{"key":"B122","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1177\/10600280221089008","article-title":"Management of venous thromboembolism in morbid obesity with rivaroxaban or warfarin","volume":"56","author":"Weaver","year":"2022","journal-title":"Ann. Pharmacother."},{"key":"B123","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1111\/jth.13741","article-title":"Chronic complications of venous thromboembolism","volume":"15","author":"Winter","year":"2017","journal-title":"J. Thromb. Haemost."},{"key":"B124","doi-asserted-by":"publisher","first-page":"3257","DOI":"10.1182\/bloodadvances.2018024893","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy","volume":"2","author":"Witt","year":"2018","journal-title":"Blood Adv."},{"key":"B125","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1159\/000329547","article-title":"Measurement of glomerular filtration rate in obese patients: pitfalls and potential consequences on drug therapy","volume":"4","author":"Wuerzner","year":"2011","journal-title":"Obes. Facts"},{"key":"B126","doi-asserted-by":"publisher","first-page":"1113111","DOI":"10.3389\/fgene.2023.1113111","article-title":"Circulating adipokine concentrations and the risk of venous thromboembolism: a Mendelian randomization and mediation analysis","volume":"14","author":"Xiao","year":"2023","journal-title":"Front. Genet."},{"key":"B127","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1093\/ajhp\/55.2.159","article-title":"Optimal weight base for a weight-based heparin dosing protocol","volume":"55","author":"Yee","year":"1998","journal-title":"Am. J. Health. Syst. Pharm."},{"key":"B128","doi-asserted-by":"publisher","first-page":"1352982","DOI":"10.3389\/fphar.2024.1352982","article-title":"Unlocking the potential of fondaparinux: guideline for optimal usage and clinical suggestions (2023)","volume":"15","author":"Yin","year":"2024","journal-title":"Front. Pharmacol."},{"key":"B129","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/bs.pmbts.2019.02.004","article-title":"The clinical use of Fondaparinux: a synthetic heparin pentasaccharide","volume":"163","author":"Zhang","year":"2019","journal-title":"Prog. Mol. Biol. Transl. Sci."},{"key":"B130","doi-asserted-by":"publisher","first-page":"10760296231153638","DOI":"10.1177\/10760296231153638","article-title":"Pharmacokinetics and dosing regimens of direct oral anticoagulants in morbidly obese patients: an updated literature review","volume":"29","author":"Zhao","year":"2023","journal-title":"Clin. Appl. Thromb. Hemost."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2024.1457280\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T06:23:31Z","timestamp":1734416611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2024.1457280\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,17]]},"references-count":130,"alternative-id":["10.3389\/fphar.2024.1457280"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2024.1457280","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,17]]},"article-number":"1457280"}}