Key result
DOACs cut major bleeding ~36% vs warfarin across normal, overweight, and obese patients.
Why the study?
Although publications have assessed DOAC safety and efficacy across BMI categories, comparative treatment effects of warfarin versus DOACs across different BMI ranges required evaluation.
Do DOACs reduce the risk of bleeding and thromboembolism compared to warfarin across different BMI categories in patients with VTE and AF?
Meta-Analysis (n=364,517)
Do DOACs reduce the risk of bleeding and thromboembolism compared to warfarin across different BMI categories in patients with VTE and AF?
Effect estimate: OR 0.64 (95% CI 0.49, 0.83)
p-value: p=0.0007
DOACs are associated with a lower risk of major bleeding compared to warfarin across normal weight, overweight, and obese BMI categories in patients with VTE and AF.
May favor DOACs over warfarin to lower major bleeding risk across BMI categories in VTE/AF; extends evidence to obese subgroups.
Background: Many publications have compared various outcomes defining safety and efficacy of DOACs across different BMI ranges. Our meta-analysis compares warfarin and DOACs for its treatment effects over different BMI ranges. Methods: A systematic search was conducted from inception to May 2021 on PubMed, Scopus and Embase databases. The data was extracted and pooled using a random effects model. Our study consisted of patients being treated for VTE and AF, across different BMI categories. For the comparison of DOAC, risk ratios (RR) with 95% confidence intervals (CIs) were used, whilst for the second comparison between warfarin and DOACs odds ratios (OR) were used. Results: In our first comparison, 12 studies (n = 254,908 patients) were included. For our second comparison, six studies (n = 109,609 patients) were included. Major bleeding events in the underweight group were higher than normal weight [RR: 1.89 (1.10, 3.23); P = 0.02; I2 = 0%]. Overweight patients were related with reduced rates of VTE than in patients with normal BMI [RR: 0.86 (0.76, 0.97); P = 0.02; I2 = 0%]. In comparison with patients receiving warfarin, DOACs had significantly reduced risk of major bleeding in normal weight, overweight and obese [OR: 0.64 (0.49, 0.83); P = 0.0007 I2 = 90%]. Conclusion: The risk of VTE reduces with an increasing BMI, hence there could be a possible obesity paradox in patients with anticoagulation therapy. In comparison to warfarin, DOACs proved to be the safer option by having a reduced risk of bleeding across all BMI categories. HIGHLIGHTS Warfarin therapy and its effectiveness for prevention of thromboembolism. Effect of warfarin and DOACs over different BMI ranges. Safety and efficacy of DOACs across different BMI ranges. Lower risk of bleeding in normal weight, overweight, and obese patients with DOACs. Warfarin and DOACs across different BMI categories in VTE and AF patients.
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Almas et al. (2022) conducted a meta-analysis in Venous thromboembolism (VTE) and atrial fibrillation (AF) (n=364,517). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Major bleeding events (OR 0.64, 95% CI 0.49, 0.83, p=0.0007). Direct oral anticoagulants significantly reduced the risk of major bleeding compared to warfarin across normal weight, overweight, and obese patients (OR 0.64).
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