The following is a summary of “Dosing Medications for Coagulopathy Reversal in Patients with Extreme Obesity” published in the October 2022 issue of Emergency Medicine by Barletta et al.

When treating patients with serious injuries, reversing anticoagulant or antiplatelet drugs is essential for reducing the risk of excessive bleeding while avoiding thrombotic consequences. However, there is scant data testing the dosage of reversal medications in the context of trauma for individuals with excessive obesity. However, doctors still need to make choices that weigh the risks of persistent bleeding against those of severe thrombosis. With the goal of providing a framework for clinicians to make dose decisions in this complex group, researchers describe the research relative to dosing of drugs used for the reversal of both drug-induced and trauma-related coagulopathy.

Both the volume of distribution and the clearance of pharmaceuticals are known to be altered by obesity; however, these modifications are not always proportional to body size nor are they consistent across drugs. Dosing options for reversal medicines in obesity now include both weight-based dosing and a capped dose (for example, prothrombin complex concentrates) (e.g., desmopressin). The trials that supported these dosing techniques, however, did not include many people who were extremely overweight or obese. 

In fact, the typical patient weight is rarely mentioned in clinical studies. The number of obese patients enrolled in clinical trials, as well as findings classified by weight class, should be reported with more frequency in future investigations. For the time being, adhere to the recommended serving sizes found on product labels. The dosage of desmopressin should be based on either optimal body weight or a dose-limiting technique.