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Drug Dosing: Obese Patients01:21

Drug Dosing: Obese Patients

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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Pharmacokinetics in Obese Patients: Drug Absorption and Distribution01:25

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Obesity significantly alters the pharmacokinetic processes of drug absorption and distribution, presenting unique challenges in medical treatment. The increased fat tissue and decreased lean muscle in obese individuals can significantly affect how drugs are absorbed into the body and distributed across different tissues. This alteration can lead to variances in the effectiveness and safety of medications, necessitating adjustments in dosing or drug selection for obese patients.One notable...
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Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion01:20

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Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
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Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
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Venous Thrombosis III: Interprofessional Care01:29

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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Aggressive Anticoagulation May Decrease Mortality in Obese Critically Ill COVID-19 Patients.

Panagiotis Drakos1, Panagiotis Volteas1, Zaina Naeem1

  • 1Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.

Obesity Surgery
|November 24, 2021
PubMed
Summary
This summary is machine-generated.

Early aggressive anticoagulation improved survival in critically ill obese COVID-19 patients. This intervention may counteract obesity

Keywords:
AnticoagulationBody mass index (BMI)COVID-19CoronavirusCritically illEnoxaparinHeparinMechanical ventilationObesity

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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Obesity Research

Background:

  • Obesity is a significant risk factor for severe COVID-19.
  • Critically ill COVID-19 patients face high mortality rates.
  • The role of anticoagulation in obese COVID-19 patients requires further investigation.

Purpose of the Study:

  • To determine the survival benefit of early aggressive anticoagulation in obese, critically ill COVID-19 patients.
  • To compare outcomes between obese and non-obese COVID-19 patients.
  • To analyze the impact of anticoagulation intensity on survival within the obese cohort.

Main Methods:

  • Retrospective review of 237 intubated COVID-19 patients at a bariatric center.
  • Stratification into obese (BMI > 30) and non-obese (BMI ≤ 30) groups.
  • Statistical analysis including chi-square tests, t-tests, Mann Whitney U-tests, Cox regression, and Kaplan-Meier models.

Main Results:

  • Overall mortality was similar between obese (47%) and non-obese (44%) groups.
  • Obese patients on early aggressive anticoagulation (AC) had significantly improved survival (26%) compared to those not on aggressive AC (61%).
  • p-value for aggressive AC in obese patients was 0.0004.

Conclusions:

  • Early aggressive anticoagulation may mitigate the adverse effects of obesity on mortality in critically ill COVID-19 patients.
  • This strategy shows promise for improving outcomes in this high-risk population.
  • Further prospective studies are warranted to confirm these findings.