肥胖和体重不足是全球范围内日益严重的健康问题,也是临床医生在抗血栓治疗方面面临的挑战。由于血栓形成和/或出血的相关风险。这份临床共识声明更新了2018年发表的一份声明,回顾了根据世界卫生组织分类的基于体型类别的抗血栓药物的最新证据。该文件主要关注极端体重的个体,即需要抗血栓药物的体重过轻和中度至病态肥胖,根据目前的指导方针,用于治疗或预防心血管疾病或静脉血栓栓塞。在这些个体中管理抗血栓治疗或血栓预防是具有挑战性的,由于身体成分的深刻变化,新陈代谢和器官功能,改变药物药代动力学和药效学,以及临床试验的证据薄弱或没有。该文件还包括从计算机药代动力学/药效学模型得出的人工智能模拟,这可以模拟药代动力学变化,并有助于确定针对体重严重不足或严重肥胖个体的抗血栓药物的最佳方案。Further,在全球范围内,病态肥胖受试者的减肥手术经常进行。减肥手术会导致新陈代谢和胃肠道解剖结构的特定和额外变化,根据程序的类型,这也会影响抗血栓药物的药代动力学及其管理。根据现有文献,该文件提供了关于优化体重不足和所有肥胖患者的抗血栓药物管理的共识声明,在强调这些复杂临床环境中当前知识差距的同时,这需要个性化医疗和精准药理学。
Obesity and
underweight are a growing health problem worldwide and a challenge for clinicians concerning antithrombotic therapy, due to the associated risks of thrombosis and/or bleeding. This clinical
consensus statement updates a previous one published in 2018, by reviewing the most recent evidence on antithrombotic drugs based on body size categories according to the World Health Organization classification. The document focuses mostly on individuals at the extremes of body weight, i.e. underweight and moderate-to-morbid obesity who require antithrombotic drugs, according to current
guidelines, for the treatment or prevention of cardiovascular diseases or venous thromboembolism. Managing antithrombotic therapy or thromboprophylaxis in these individuals is challenging, due to profound changes in body composition, metabolism and organ function, altered drug pharmacokinetics and pharmacodynamics, as well as weak or no evidence from clinical trials. The document also includes artificial intelligence simulations derived from in silico pharmacokinetic/pharmacodynamic models, which can mimic the pharmacokinetic changes and help identify optimal regimens of antithrombotic drugs for severely underweight or severely obese individuals. Further, bariatric surgery in morbidly obese subjects is frequently performed worldwide. Bariatric surgery causes specific and additional changes in metabolism and gastrointestinal anatomy, depending on the type of the procedure, which can also impact the pharmacokinetics of antithrombotic drugs and their management. Based on existing literature, the document provides
consensus statements on optimising antithrombotic drug management for
underweight and all classes of obese patients, while highlighting the current gaps in knowledge in these complex clinical settings, which require personalized medicine and precision pharmacology.