Key result
DOACs cut major events ~28% vs. warfarin in obese patients with AF.
Why the study?
Anticoagulation in obese patients with AF prevents thromboembolism, but the safety and efficacy of different anticoagulants in this population are not well explored.
Does DOAC therapy reduce thromboembolic events and bleeding compared to warfarin in obese patients with atrial fibrillation?
Meta-Analysis (n=387,205)
Yes
Does DOAC therapy reduce thromboembolic events and bleeding compared to warfarin in obese patients with atrial fibrillation?
Odds Ratio: 0.72 (95% CI 0.63–0.81)
Absolute Event Rate: 2.34% vs 3.17%
DOACs demonstrate superior efficacy and safety compared to warfarin in obese patients with atrial fibrillation, significantly reducing the composite thromboembolic risk, major bleeding, and all-cause mortality across all obesity classes.
May support DOAC preference over warfarin in obese AF; extends mostly observational data and requires dedicated RCTs.
Background and Aim: Obesity affects nearly 650 million adults worldwide, and the prevalence is steadily rising. This condition has significant adverse effects on cardiovascular health, increasing the risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation (AF). While anticoagulation for obese patients with AF is a well-established therapy for the prevention of thromboembolism, the safety and efficacy of different anticoagulants in this specific population are not well explored. This meta-analysis aimed to compare direct oral anticoagulants (DOAC) to vitamin K antagonists in obese populations with AF. Methods: The PRISMA guidelines were followed for this meta-analysis, registered in PROSPERO (CRD42023392711). PubMed, PubMed Central, Embase, Cochrane Library, and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened titles and abstracts, followed by a full-text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as an effect measure. Results: Two thousand two hundred fifty-nine studies were identified from the database search, and 18 were included in the analysis. There were statistically significant reductions in the odds of ischemic and hemorrhagic stroke in the DOAC group compared with the VKA group (OR 0.70, CI 0.66-0.75) and (OR 0.47, CI 0.35-0.62), respectively. In addition, the DOAC group exhibited lower odds of systemic embolism (OR 0.67, CI 0.54-0.83), major bleeding (OR 0.62, CI 0.54-0.72), and composite outcome (OR 0.72, CI 0.63-0.81). Conclusion: Based on the findings from this meta-analysis, DOACs demonstrate superior safety and efficacy in obese patients with AF compared with VKAs. These results may have significant implications for guiding anticoagulation strategies in this patient population.
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Adelkhanova et al. (2024) conducted a meta-analysis in Atrial fibrillation in obese patients (n=387,205). Direct oral anticoagulants (DOAC) vs. Vitamin K antagonists (Warfarin) was evaluated on Composite of stroke, systemic embolism, myocardial infarction (MI), or any cause of death (OR 0.72, 95% CI 0.63-0.81). Direct oral anticoagulants reduced the composite outcome of stroke, systemic embolism, MI, or death by 28% compared to warfarin in obese patients with atrial fibrillation (OR 0.72).
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