The "Obesity Paradox" and the use of NOAC

Obesity is a worldwide health problem at increasing incidence associated with high morbidity and mortality. Although obesity increases patients' cardiovascular (CV) risk, more and more evidences suggest a favorable prognosis in obese subjects with cardiovascular disease (CVD), a phenomenon known as "obesity paradox." Obesity paradox has been demonstrated in various CVD including atrial fibrillation (AF) and venous thromboembolism (VTE) for which anticoagulation therapy is mandatory. Little is still known about the use of non-vitamin K oral anticoagulants (NOACs) in extreme obese patients, so major guidelines discourage their use in this subset of patients. Due to the lack of data and clinical interest of the topic, we aim to review the concept of obesity paradox applied to AF and VTE, for then examine the available data on the prognosis of obese patients being treated with NOACs.