Successful use of rivaroxaban achieving therapeutic anti-factor xa levels in a morbidly obese patient with acute intermediate-high risk pulmonary embolism

Abstract Direct oral anticoagulants (DOACs) have become the standard of care for acute and long-term therapy venous thromboembolism (VTE) due to their efficacy safety profiles. The 2021 International Society on Thrombosis Haemostasis guidelines recommend using DOAC dosages in patients with BMI >40 kg/m2 or weight >120 kg. Use DOACs remains uncertain morbidly obese VTE, including PE. A woman her 30s who presented worsening dyspnea was diagnosed intermediate-high risk pulmonary embolism concomitant proximal deep vein thrombosis, constituting a clinically challenging scenario treating rivaroxaban. Standard doses rivaroxaban extended phase treatment individuals morbid obesity at BMI>70 may be effective, safe.