Arq. Bras. Cardiol. 2024; 121(8): e20240496

Use of Anticoagulant Therapy in Obese People: What is the Evidence for the Ideal Dose?

Marcia M. Noya-Rabelo , Eduardo Novaes, Renata Moll-Bernardes, Olga Souza

DOI: 10.36660/abc.20240496i

This Short Editorial is referred by the Research article "Fondaparinux versus Enoxaparin in the Treatment of Obese Patients with Acute Coronary Syndrome".

Data from the World Health Organization indicate that more than 1 billion people in the world, one in eight, are obese. In Brazil, according to research by the Chronic Disease Risk Factor Surveillance by Telephone Survey (VIGITEC), one in every four people in the adult population is obese. Obesity is defined by a body mass index (BMI) greater than or equal to 30 kg/m², while morbid obesity is considered for those with a BMI above 40 kg/m². Epidemiological data also points to a high prevalence of coronary disease in the Brazilian population, estimated at 5 to 8%.

Although obesity rates have reached epidemic proportions worldwide, the medical literature lacks precise data on changes in the pharmacokinetics and pharmacodynamics of different medications in patients with obesity. Possible physiological differences between obese and non-obese individuals may result in differences in the distribution and elimination of drugs, important factors to be considered when determining the appropriate dosage for pharmacological treatment. The ideal dose of most anticoagulants for obese people has not been established, including low molecular weight heparin and pentasaccharides. In this way, the therapeutic management of patients with acute coronary syndrome (ACS) and obesity is challenging and, consequently, can influence the efficacy and safety of anticoagulants.

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