Antithrombotic therapy and body mass: an expert position paper of the ESC Working Group on Thrombosis

Increasing prevalence of cardiovascular disease and new evidence on the effects of antithrombotic therapies have expanded the use of antiplatelet and anticoagulant drugs. In addition, extremely low and high body weights have become more common due to frailty associated with ageing and to the global epidemic of obesity, ‘globesity’, respectively. These extreme body weights affect cardiovascular risk, including mortality, as well as the pharmacokinetics and safety profiles of antithrombotic drugs, some of which have a relatively narrow therapeutic window. The ESC Working Group on Thrombosis therefore assembled a task group to examine the key issues related to this topic and to address the question of whether modified antithrombotic management strategies are required for patients at the extremes of body weight. Greater focus is directed toward to obesity, given its higher prevalence among patients with cardiovascular disease and its associated complexities in terms of pharmacology and pathophysiology. Further research is warranted to optimize antithrombotic therapy in underweight as well as in different classes of obese patients, to guide dosing, dose-adjustment and/or reference intervals, and to establish whether the balance of benefits and risks of antithrombotic drugs can be improved.