Obesity has a variable effect on different rivaroxaban pharmacokinetic (PK) parameters and needs be used with caution in this population, as changes in the anticoagulation activity may occur upon long-term therapy.

Well-designed, prospective studies addressing the quality issues identified here in the Crowe Critical Appraisal Tool (CCAT) and Critical Appraisal of Clinical Pharmacokinetic Studies (CACPK) assessments need to be conducted to investigate rivaroxaban PK in the obese population.

This will assist to establish solid and definitive evidence to be used in clinical practice guidelines for effective and safe dosage regimen recommendations of rivaroxaban in this population.