DOACs Outperform Warfarin for VTE in Morbid Obesity

This meta-analysis strengthens the case that standard-dose direct acting oral anticoagulants (DOACs) are effective and safe for venous thromboembolism (VTE) in patients with morbid obesity, supporting recent guideline liberalization.

apixabanrivaroxabanDOACwarfarinvenous thromboembolismmorbid obesityanticoagulationmeta-analysisbleedingISTH Endocrinology / Diabetes / Obesity

Background Information

DOACs might outperform warfarin for VTE in morbid obesity.

Direct acting oral anticoagulants (DOACs) are increasingly used for venous thromboembolism (VTE) but their efficacy and safety in morbidly obese patients were previously unclear. DOACs demonstrated a lower risk of thrombosis recurrence (OR = 0.74) and major bleeding (OR = 0.69) compared to warfarin in morbidly obese VTE patients. DOACs may offer a better safety and efficacy profile than warfarin in morbidly obese patients with VTE, suggesting standard dosing without adjustments may be effective. DOACs are potentially safer and more effective than warfarin for VTE in morbid obesity.

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Authors: Shi J, Zhang Y, Tang Y, Wang L, Xiao H

Citation: Shi J, Zhang Y, Tang Y, et al. Safety and efficacy of direct acting oral anticoagulants in the treatment of patients with morbid obesity with venous thromboembolism: A meta-analysis. Medicine. 2026;105(34):e50355. doi:10.1097/MD.0000000000050355

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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