Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Obese Patients with Atrial Fibrillation

Alexandros Briasoulis; Amgad Mentias; Alexander Mazur; Paulino Alvarez; Enrique C Leira; Mary S Vaughan Sarrazin

doi:10.1007/s10557-020-07126-2

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Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Obese Patients with Atrial Fibrillation

Journal article

Peer reviewed

Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Obese Patients with Atrial Fibrillation

Alexandros Briasoulis, Amgad Mentias, Alexander Mazur, Paulino Alvarez, Enrique C Leira and Mary S Vaughan Sarrazin

Cardiovascular drugs and therapy, Vol.35(2), pp.261-272

04/2021

DOI: 10.1007/s10557-020-07126-2

PMID: 33404923

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https://www.ncbi.nlm.nih.gov/pmc/articles/8382577View

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Abstract

Unlike warfarin direct oral anticoagulants (DOACs) are administered in fixed doses, which raises concerns of its effectiveness on larger patients. Data from randomized trials are limited on the safety and efficacy of DOACs in morbidly obese individuals with atrial fibrillation (AF). We analyzed a cohort of obese (≥ 120 kg) and morbidly obese (BMI > 40 kg/m ) patients from the Veterans Health Administration system with AF who initiated apixaban, rivaroxaban, dabigatran, or warfarin between years 2012 and 2018. We used inverse probability of treatment weighting (IPTW) and Cox proportional hazards regression models to evaluate the relative hazard of death, myocardial infarction (MI), ischemic stroke, heart failure (HF), and bleeding events between oral anticoagulant (OAC) groups while censoring for medication cessation. We identified 6052 obese patients on apixaban, 4233 on dabigatran, 4309 on rivaroxaban, and 13,417 on warfarin (mean age 66.7 years, 91% males, 80.4% whites). At baseline patients on apixaban had the lowest glomerular filtration rate and highest rates of previous stroke and MI compared to other OACs. Among patients with weight ≥ 120 kg and those with BMI > 40 kg/m , all DOACs were associated with lower risk of any hemorrhage, hemorrhagic stroke, and gastrointestinal (GI) bleeding. Patients with BMI > 40 kg/m treated with DOACs had similar ischemic stroke risk with those on warfarin. In this large cohort of obese Veterans Health Administration system patients, the use of DOACs resulted in lower hemorrhagic complications than warfarin while maintaining efficacy on ischemic stroke prevention.

Obesity

Stroke

Direct oral anticoagulants

Atrial fibrillation

Bleeding

Details

Title: Subtitle: Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Obese Patients with Atrial Fibrillation
Creators: Alexandros Briasoulis - National Kapodistrian University of Athens, Medical School, Athens, Greece. alexbriasoulis@gmail.com
Amgad Mentias - National Kapodistrian University of Athens, Medical School, Athens, Greece
Alexander Mazur - National Kapodistrian University of Athens, Medical School, Athens, Greece
Paulino Alvarez - National Kapodistrian University of Athens, Medical School, Athens, Greece
Enrique C Leira - Departments of Neurology and Neurosurgery, Carver College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
Mary S Vaughan Sarrazin - Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Cardiovascular drugs and therapy, Vol.35(2), pp.261-272
DOI: 10.1007/s10557-020-07126-2
PMID: 33404923
NLM abbreviation: Cardiovasc Drugs Ther
ISSN: 0920-3206
eISSN: 1573-7241
Publisher: United States
Language: English
Date published: 04/2021
Academic Unit: Neurology; Health Management and Policy; Epidemiology; Iowa Neuroscience Institute; Cardiovascular Medicine; General Internal Medicine; Neurosurgery; Internal Medicine
Record Identifier: 9984070864202771

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