2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

. Author manuscript; available in PMC: 2024 May 15.

Published in final edited form as: Circulation. 2023 Nov 30;149(1):e1–e156. doi: 10.1161/CIR.0000000000001193

Recommendations for Anticoagulation Considerations in Patients With Class III Obesity

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	Recommendations
2a	B-NR	1. In patients with AF and class III obesity (BMI ≥ 40 kg/m²), DOACs are reasonable to choose over warfarin for stroke risk reduction.^1–5
2b	C-LD	2. In patients with AF who have undergone bariatric surgery, warfarin may be reasonable to choose over DOACs for stroke risk reduction in view of concerns about DOAC drug absorption.^6,7