Clinical Research in Cardiology

, Volume 106, Issue 8, pp 565–572 | Cite as

The non-vitamin K antagonist oral anticoagulants (NOACs) and extremes of body weight—a systematic literature review

  • Raffaele De CaterinaEmail author
  • Gregory Y. H. Lip


The non-vitamin K antagonist oral anticoagulants (NOACs) exert their anticoagulant effect closely related to their plasma concentrations. Since their distribution volume is related to body weight (and its correlates, i.e., surface area and body mass index, BMI), extremes in body weight may affect their efficacy or safety. Four NOACs are currently available for long-term use, with few exceptions, in atrial fibrillation and venous thromboembolism: the direct thrombin inhibitor dabigatran etexilate, and the factor (F) Xa inhibitors rivaroxaban, apixaban, and edoxaban. Experience in patients with low (<50 kg) or extremely high (>150 kg) body weight is still quite limited, as such patients were rare in registration trials and sometimes directly excluded. In general, increased bleeding and higher mortality rates are observed in patients weighing <50 kg compared with patients weighing 50–100 kg. This may however also be explained by the presence of underlying conditions such as cancer. At the opposite end of the spectrum of body weight, lower antithrombotic efficacy may occur, perhaps due to the dilutional effect of a higher distribution volume. In this article, we review the pertinent literature and analyze the effects of low or high body weight on anticoagulant activity and clinical outcomes of the NOACs, their dose recommendations, and areas of uncertainty.


Non-vitamin K antagonist oral anticoagulants NOACs Body weight Body mass index BMI Obesity Bleeding Stroke Mortality 




RDC has served as a Consultant for Bayer, Merck, Sanofi Aventis, BMS/Pfizer, Daiichi-Sankyo, Lilly, Novartis, Roche, Portola, and Boehringer-Ingelheim; has received grants (to his University) from Boehringer-Ingelheim, Bayer, BMS/Pfizer; and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer-Ingelheim, Daiichi-Sankyo. G.Y.H.L. has served as a Consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer-Ingelheim, Microlife and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer-Ingelheim, Microlife, Roche, and Daiichi-Sankyo.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.“G. d’Annunzio” University and Center of Excellence on Aging – CeSI-MetChietiItaly
  2. 2.University of Birmingham Institute of Cardiovascular ScienceBirminghamUK

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