Why the study?
Limited data exist on the efficacy and safety of fixed-dose direct-acting oral anticoagulants in severe obesity, where altered pharmacokinetics and pharmacodynamics may occur.
Do direct-acting oral anticoagulants provide similar efficacy and safety for stroke prevention in atrial fibrillation patients with obesity compared to those with normal BMI?
Population
7642 patients with atrial fibrillation receiving direct-acting oral anticoagulants
Comparison
Excess BMI categories vs normal BMI
Design
Retrospective study at an integrated multisite healthcare system
Follow-up
Median 3.8 (2.2–6.0) years
Key result
In patients with atrial fibrillation taking direct-acting oral anticoagulants, class 1 obesity was associated with a similar risk of stroke compared to normal BMI (HR 1.2; 95% CI 0.5-2.9).
Authors
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Similar stroke risk on DOACs in class 1 obesity does not support practice change; leaves open need for randomized confirmation across BMI.
Cohort (n=7,642)
Yes
Do direct-acting oral anticoagulants provide similar efficacy and safety for stroke prevention in atrial fibrillation patients with obesity compared to those with normal BMI?
Hazard Ratio: 1.2 (95% CI 0.5–2.9)
Direct-acting oral anticoagulants demonstrate similar efficacy and safety for stroke prevention in atrial fibrillation across all BMI categories, including severe obesity.
Kaplan et al. (2020) conducted a cohort in Atrial fibrillation (n=7,642). Excess BMI categories (Class 1, 2, or 3 obesity) vs. Normal BMI was evaluated on Ischemic stroke or systemic embolism (HR 1.2, 95% CI 0.5-2.9). In patients with atrial fibrillation taking direct-acting oral anticoagulants, class 1 obesity was associated with a similar risk of stroke compared to normal BMI (HR 1.2; 95% CI 0.5-2.9).