Efficacy and safety of direct oral anticoagulant in morbidly obese patients with atrial fibrillation: systematic review and meta-analysis

Sittinun Thangjui; Jakrin Kewcharoen; Ratdanai Yodsuwan; Angkawipa Trongtorsak; Harshith Thyagaturu; Bishesh Shrestha; Amanda R M Winans; Edward Bischof

doi:10.1093/ehjcvp/pvab026

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Efficacy and safety of direct oral anticoagulant in morbidly obese patients with atrial fibrillation: systematic review and meta-analysis

Journal article

Open access

Peer reviewed

Efficacy and safety of direct oral anticoagulant in morbidly obese patients with atrial fibrillation: systematic review and meta-analysis

Sittinun Thangjui, Jakrin Kewcharoen, Ratdanai Yodsuwan, Angkawipa Trongtorsak, Harshith Thyagaturu, Bishesh Shrestha, Amanda R M Winans and Edward Bischof

European heart journal. Cardiovascular pharmacotherapy, Vol.8(4), pp.325-335

07/01/2022

DOI: 10.1093/ehjcvp/pvab026

PMID: 33730164

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Abstract

We conducted a systematic review and meta-analysis on three outcomes. We assessed the efficacy and safety of direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) in morbidly obese patients with atrial fibrillation (AF). We compared the efficacy and safety of DOAC in obese patients and non-obese patients with AF. Finally, we updated the current knowledge of outcomes of AF patients with obesity compared with normal-weight patients regardless of anticoagulation type. Using PubMed and Embase, we searched for literature published from inception to August 2020 for studies conducted in morbidly obese patients with AF who used DOACs and/or VKA for stroke or systemic embolism (stroke/SE) prevention that report efficacy and/or safety data. GRADE assessment was performed to determine the quality of the meta-analysis results. Direct oral anticoagulant was not statistically different from VKA in reducing stroke/SE with relative risk (RR) of 0.85 [95% confidence interval (CI): 0.56-1.29; very low certainty evidence]. Major bleeding risk was lower in the DOAC groups with RR of 0.62 (95% CI: 0.48-0.80; low certainty evidence). Obese patients with AF who used DOACs had lower risk of stroke/SE and similar major bleeding risk compared to non-obese patients with RR of 0.77 (95% CI: 0.70-0.84; low certainty evidence) and 1.02 (95% CI: 0.94-1.09; low certainty evidence), respectively. Obese patients with AF who used any type of anticoagulant had lower risk of stroke/SE compared to normal-weight patients with RR of 0.62 (95% CI: 0.57-0.69; low certainty evidence). The use of DOACs in morbidly obese patients may be reasonable if needed, and more dedicated studies are needed to make a more robust recommendation.

Administration, Oral

Anticoagulants - adverse effects

Atrial Fibrillation - complications

Atrial Fibrillation - diagnosis

Atrial Fibrillation - drug therapy

Embolism

Fibrinolytic Agents - therapeutic use

Hemorrhage - chemically induced

Humans

Obesity, Morbid - chemically induced

Obesity, Morbid - complications

Obesity, Morbid - diagnosis

Stroke - diagnosis

Stroke - epidemiology

Stroke - etiology

Details

Title: Subtitle: Efficacy and safety of direct oral anticoagulant in morbidly obese patients with atrial fibrillation: systematic review and meta-analysis
Creators: Sittinun Thangjui - Bassett Healthcare Network
Jakrin Kewcharoen - University of Hawaii System
Ratdanai Yodsuwan - Bassett Healthcare Network
Angkawipa Trongtorsak - Saint Francis Hospital
Harshith Thyagaturu - Bassett Healthcare Network
Bishesh Shrestha - Bassett Healthcare Network
Amanda R M Winans - Bassett Healthcare Network
Edward Bischof - Bassett Healthcare Network
Resource Type: Journal article
Publication Details: European heart journal. Cardiovascular pharmacotherapy, Vol.8(4), pp.325-335
DOI: 10.1093/ehjcvp/pvab026
PMID: 33730164
NLM abbreviation: Eur Heart J Cardiovasc Pharmacother
ISSN: 2055-6837
eISSN: 2055-6845
Language: English
Date published: 07/01/2022
Academic Unit: Internal Medicine
Record Identifier: 9984694746902771

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12 Times Cited - Web of Science