Non-Valvular Atrial Fibrillation, Obesity, and the Use of DOACs: Considerations for Pharmacists

This activity includes a Patient Interaction Simulation.

Program Description

The rate of obesity in the United States has more than tripled in the past 2 decades. Individuals who are obese are at greater risk for cardiovascular disease, such as atrial fibrillation (AF), and often require medications such as direct oral anticoagulants (DOACs). Non-valvular AF often occurs due to high blood pressure. It is typical for medications to be dosed adjusted based on weight, but for obese patients adipose tissue can change, making it imperative that pharmacists recognize and properly adjust weight-based dosing requirements. However, none of the medication labeling for currently approved DOACs lists dose adjustments for patients with BMI greater than 30. Pharmacists can advise physicians about limitations of use of DOACs in patients with non-valvular AF and obesity. This activity will review the pharmacokinetics and pharmacodynamics for DOACs, and equip pharmacists to assist in providing individualized patient care based on disease state, potential drug interactions, and lifestyle or diet. An interactive patient simulation will allow pharmacists to experience clinical decision making for patients with obesity who require use of DOACs.

Target audience: Health System Pharmacist, Retail Pharmacist

Type of activity: Application
Release date: July 21, 2022
Expiration date: July 21, 2023

Time to complete activity: 2.5 hours
Fee: Free

Educational Objectives

At the completion of this activity, participants will be able to:

• Explore the pharmacokinetics and pharmacodynamics of FDA-approved dosing for apixaban, dabigatran, edoxaban, and rivaroxaban as it relates to body weight and obesity
• Analyze standards of care, efficacy, and safety data from randomized controlled trials on direct oral anticoagulants (DOACs) versus warfarin in patients with atrial fibrillation and obesity or extreme obesity
• Identify the role of the pharmacist in patient management, including supportive assessment, effective treatment decision making that considers DOACs versus warfarin, identification of patients, monitoring of response and follow-up, and adverse effect monitoring

Pharmacy Times Continuing Education™ is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 2.5 contact hours (0.25 CEU) under the ACPE universal activity number 0290-0000-22-326-H01-P. The activity is available for CE credit through July 21, 2023.

Instructions for Completing the Activity and Receiving CPE Credit

To receive CPE credit, participants must complete the pretest, read the article in its entirety, complete the posttest, and complete the online activity evaluation. After successful completion of the online activity evaluation, you can submit your credit to CPE Monitor. You may view your credit within 48 hours at www.mycpemonitor.net. All participants must request credit before the activity expiration date. CE credit will not be issued after this date.

Disclosures

The following contributors have no relevant financial relationships with commercial interests to disclose:

Faculty

Sarah Hanigan, PharmD

Pharmacy Times Continuing Education™ Planning Staff—Jim Palatine, RPh, MBA; Maryjo Dixon, RPh; Michelle Carlson, PharmD; Kylie Ferrentino; Susan Pordon; Brianna Winters; and Chloe Taccetta

Pharmacy Times® Editorial Staff—Davy James

An anonymous peer reviewer was used as part of content validation and conflict resolution. The peer reviewer has no relevant financial relationships with commercial interests to disclose.

Educational Disclaimer
CPE activities are offered solely for educational purposes and do not constitute any form of professional advice or referral. Discussions concerning drugs, dosages, and procedures may reflect the clinical experience of the author(s) or they may be derived from the professional literature or other sources and may suggest uses that are investigational in nature and not approved labeling or indications. Participants are encouraged to refer to primary references or full prescribing information resources.

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