How would you manage a patient with morbid obesity who presents with new symptomatic pulmonary embolism a few days after he was started on DOAC for DVT?  

There are guidelines from the American Society of Hematology and The International Society of Hemostasis and Thrombosis as well as expert opinions recommending either apixaban or rivaroxaban for venous thromboembolism or pulmonary embolism in patients with BMI >40. In addition, this includes use ...

I am comfortable giving DOACs to patients with high BMI based on the data outlined by Dr. @Kraut, unless they have had gastric surgery for weight loss. I would wonder if this "new" PE was actually there at the time of the DVT diagnosis based on older studies that 30%-50% of patients with DVT have as...

Updated answer I CANNOT assume the DOAC is working. It PROBABLY is, since failure may simply be that a clot has broken off which was going to happen anyway. BUT LET’S BE THOROUGH AND ASSUME THE WORST AS WE SORT THIS OUT. First, check patient compliance. Second, if on Xarelto, be sure the pati...

Provided the patient has been receiving rivaroxaban or apixaban, which are the recommended DOACS in patients with BMI >40 according to the ISTH guidelines, and assuming that it has been clearly ascertained that this is a new VTE, I would manage this situation the same way I manage any case of ant...

I would not recommend using DOAC in the obese population, BMI > 35-40, since there is little data on obese patients on DOAC. I would also be concerned that fixed dosing in a morbidly obese patient may have lower drug level and lower efficacy. Also, I believe the safety data on DOACs, are mostly ...