Antithrombotic therapy and body mass: an expert position paper of the ESC Working Group on Thrombosis

The success of trials that have shown net clinical benefits of antithrombotic drugs as well as the increasing prevalence of cardiovascular diseases in an ageing population have led to more widespread use of antiplatelet and anticoagulant drugs. At the same time, extremely low and high body weight (BW) are becoming more common due to a higher prevalence of frailty, associated with greater life expectancy, and the global epidemic of obesity, ‘globesity’, respectively.1–3 These extreme BWs may affect cardiovascular risk as well as the pharmacokinetics of antithrombotic drugs, some of which have relatively narrow therapeutic windows. The ESC Working Group on Thrombosis consequently assembled a task group to examine the key issues related to this topic and to address the question of whether modified antithrombotic management strategies are required for patients at the extremes of BW. Greater focus is given to obesity due to its higher prevalence among patients with cardiovascular disease and the associated complexities in terms of pharmacology and pathophysiology.