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Table 7 High-risk obese patient subgroups that may require variations of VTE treatment

From: Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

QuestionExpert opinionGuideline recommendations
Do considerations for treatment of obese patients at high risk of VTE vary between patient subgroups?• Subgroups in obese patients are poorly studied
• Treatments vary between different patient weight groups: obese, morbidly obese
• The subgroup of obese patients > 120 kg is problematic
• Different weight groups require different anticoagulant treatments
• Standardised treatment regimens with enoxaparin exist in some hospitals
• Medical and surgical obese patients need to be considered as two separate groups
• Bariatric surgery or non-bariatric surgery patients and medical patients should be considered separately
• Surgical obese patients should be differentiated into those undergoing bariatric surgery or any other surgery
• There are differences in how these patients are defined as high risk
ACCP [28]:
• Graduated compression stockings are recommended for severely obese patients considering long distance travel
ISTH [76]:
• Standard dosing of DOACs is recommended for obese patients with a weight < 120 kg
• DOACs should not be used in obese patients with a weight > 120 kg but if they are then drug-specific peak and trough levels should be checked
NICE [38]:
• Further research is needed regarding dose strategies of LMWH for very obese people (BMI > 35) who are admitted to hospital or receiving day procedures
• Mechanical prophylaxis is recommended for patients undergoing bariatric surgery
RCOG [13]:
• Risk of VTE during pregnancy increases with a BMI > 25 and ante-partum immobilisation
SOGC [30]:
• Recommended dose increases for UFH, enoxaparin, dalteparin and tinzaparin are indicated for obese pregnant women
Thrombosis Canada [78]:
• Obese patients between 40–100 kg are recommended higher doses of dalteparin, enoxaparin and tinzaparin than patients < 40 kg to be taken once daily. This dose is increased to twice daily for those weighing 101–120 kg
  1. ACCP, American College of Chest Physicians; BMI, body mass index; DOAC, direct oral anticoagulant; ISTH, International Society of Thrombosis and Haemostasis; LMWH, low-molecular-weight heparin; NICE, National Institute for Health and Care Excellence; RCOG, Royal College of Obstetricians and Gynaecologists; SOGC, Society of Obstetricians and Gynaecologists of Canada; UFH, unfractionated heparin; VTE, venous thromboembolism