Why the study?
Guideline updates highlighted concerns regarding DOAC use for thromboembolic prevention in NVAF patients at extreme BMI spectrums exceeding 35 kg/m2 or weight surpassing 120 kg.
Do direct oral anticoagulants (DOACs) improve efficacy and safety compared to warfarin in very morbidly obese patients with non-valvular atrial fibrillation?
Do direct oral anticoagulants (DOACs) improve efficacy and safety compared to warfarin in very morbidly obese patients with non-valvular atrial fibrillation?
DOACs were associated with similar stroke and bleeding risks versus warfarin in very morbidly obese NVAF; leaves open need for randomized confirmation.
In the management of nonvalvular atrial fibrillation (NVAF), the adoption of direct oral anticoagulants (DOACs) has progressively outpaced the use of warfarin for thromboembolic prevention [1,2]. Historically, the 2019 focused update by the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Rhythm Society (HRS) highlighted concerns regarding DOAC use in individuals at the extremes of the body mass index (BMI) spectrum, particularly those with a BMI exceeding 35 kg/m2 or a weight surpassing 120 kg [3].
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Ezaldin et al. (2025) studied this question.
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