What is the clinical evidence from this study?

Study design: Case-Control. Population: Atrial fibrillation (n=1854). Intervention: Dabigatran vs. No oral anticoagulant. Primary outcome: Ischaemic stroke or transient ischaemic attack (IS/TIA) (aOR 0.50, 95% CI 0.38-0.68, p=<0.001).

What does this research mean for the field?

Dabigatran use is associated with a lower risk of ischemic stroke or transient ischemic attack in patients with atrial fibrillation, with no clear statistical evidence that this benefit is modified by BMI, although attenuation in Class III obesity cannot be ruled out. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the association between dabigatran use and ischaemic stroke or transient ischaemic attack across body mass index categories in patients with atrial fibrillation.

September 8, 2026Journal of Thrombosis and ThrombolysisOpen Access

Dabigatran use and cerebrovascular event risk across body mass index in atrial fibrillation: a real-world nested case–control study

Q: What are the key findings of this study?

Dabigatran use was associated with a 50% lower odds of ischemic stroke or transient ischemic attack compared to no oral anticoagulant in patients with atrial fibrillation (aOR 0.50).

Q: What does this research mean for the field?

Dabigatran use is associated with a lower risk of ischemic stroke or transient ischemic attack in patients with atrial fibrillation, with no clear statistical evidence that this benefit is modified by BMI, although attenuation in Class III obesity cannot be ruled out. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between dabigatran use and ischaemic stroke or transient ischaemic attack across body mass index categories in patients with atrial fibrillation.

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Why the study?

Dabigatran is widely used for stroke prevention in AF, but concerns remain regarding its effectiveness in patients with Class III obesity.

Does dabigatran use reduce incident ischaemic stroke or transient ischaemic attack in patients with atrial fibrillation across different BMI categories?

Population

1,854 patients with AF (295 cases, 1,559 controls) in New Zealand

Comparison

Dabigatran use vs non-use across BMI categories

Design

Retrospective nested case-control study

Key result

Dabigatran use was associated with a 50% lower odds of ischemic stroke or transient ischemic attack compared to no oral anticoagulant in patients with atrial fibrillation (aOR 0.50).

Authors

KMKarim Mahawish VFValery L. Feigin PBP. Alan Barber

Discussion

Member takes

Overview

Dabigatran was associated with lower IS/TIA odds across BMI; leaves open efficacy in class III obesity pending randomized data.

Key Points

To evaluate the association between dabigatran use and ischaemic stroke or transient ischaemic attack across body mass index categories in patients with atrial fibrillation.
Conducted a retrospective nested case–control study of 1,854 patients with atrial fibrillation (295 incident ischaemic stroke/TIA cases from the Auckland Regional Community Stroke Study and 1,559 controls from the National Minimum Dataset).
Evaluated dabigatran exposure and assessed effect modification across BMI tiers (<30, 30–39.9, and ≥40 kg/m²) using multivariable logistic regression interaction terms.
Dabigatran use overall was associated with significantly reduced odds of ischaemic stroke or TIA (aOR 0.50, 95% CI 0.38–0.68).
Effect modification by BMI category was not statistically significant (p-interaction = 0.49), showing similar risk reductions in patients with BMI <30 and 30–39.9 kg/m².
In Class III obesity (BMI ≥40 kg/m²), the point estimate shifted toward the null and was imprecise, meaning clinically important attenuation could not be excluded.

Study Design

Type

Case-Control (n=1,854)

Multicenter

Yes

Structured PICO

Does dabigatran use reduce incident ischaemic stroke or transient ischaemic attack in patients with atrial fibrillation across different BMI categories?

Population

1,854 adult patients with atrial fibrillation, including 295 with incident ischemic stroke or TIA and 1,559 event-free controls, evaluated for the association between dabigatran use and cerebrovascular events across BMI categories.

Exposure

Dabigatran use

Comparator

No dabigatran use

Outcome

Incident ischaemic stroke (IS) or transient ischaemic attack (TIA)hard clinical

Main Result

Odds Ratio: 0.5 (95% CI 0.38–0.68)

p-value: p=<0.001

Dabigatran use is associated with a 50% reduction in the odds of ischemic stroke or TIA in patients with atrial fibrillation, with no significant effect modification by BMI, although efficacy in Class III obesity remains uncertain.

Limitations

Case-control design precludes causal inference and residual confounding cannot be excluded.
Adherence derived from dispensing data may not fully reflect actual medication use.
Limited statistical power in patients with Class III obesity (BMI ≥40 kg/m2) due to small sample size.
BMI does not fully capture adiposity or fat distribution and may misclassify risk across ethnic groups.
Use of non-anticoagulated patients as the reference group may introduce confounding by indication and healthy-user or frailty-related bias.
Could not distinguish new users from prevalent users due to lack of historical dispensing data.
Limited power in patients with BMI ≥40 kg/m2
Clinically important attenuation in Class III obesity could not be excluded

Cite This Study

Mahawish et al. (2026) conducted a case-control in Atrial fibrillation (n=1,854). Dabigatran vs. No oral anticoagulant was evaluated on Ischaemic stroke or transient ischaemic attack (IS/TIA) (aOR 0.50, 95% CI 0.38-0.68, p=<0.001). Dabigatran use was associated with a 50% lower odds of ischemic stroke or transient ischemic attack compared to no oral anticoagulant in patients with atrial fibrillation (aOR 0.50).

synapsesocial.com/papers/6a9fd82058e84d0ff5b47698 https://doi.org/10.1007/s11239-026-03394-1

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September 8, 2026Journal of Thrombosis and ThrombolysisOpen Access

Dabigatran use and cerebrovascular event risk across body mass index in atrial fibrillation: a real-world nested case–control study

View Full Paper

Ask AI

Bookmark

Why the study?

Dabigatran is widely used for stroke prevention in AF, but concerns remain regarding its effectiveness in patients with Class III obesity.

Does dabigatran use reduce incident ischaemic stroke or transient ischaemic attack in patients with atrial fibrillation across different BMI categories?

Population

1,854 patients with AF (295 cases, 1,559 controls) in New Zealand

Comparison

Dabigatran use vs non-use across BMI categories

Design

Retrospective nested case-control study

Key result

Dabigatran use was associated with a 50% lower odds of ischemic stroke or transient ischemic attack compared to no oral anticoagulant in patients with atrial fibrillation (aOR 0.50).

Authors

KMKarim Mahawish VFValery L. Feigin PBP. Alan Barber

Discussion

Member takes

Overview

Dabigatran was associated with lower IS/TIA odds across BMI; leaves open efficacy in class III obesity pending randomized data.

Key Points

To evaluate the association between dabigatran use and ischaemic stroke or transient ischaemic attack across body mass index categories in patients with atrial fibrillation.
Conducted a retrospective nested case–control study of 1,854 patients with atrial fibrillation (295 incident ischaemic stroke/TIA cases from the Auckland Regional Community Stroke Study and 1,559 controls from the National Minimum Dataset).
Evaluated dabigatran exposure and assessed effect modification across BMI tiers (<30, 30–39.9, and ≥40 kg/m²) using multivariable logistic regression interaction terms.
Dabigatran use overall was associated with significantly reduced odds of ischaemic stroke or TIA (aOR 0.50, 95% CI 0.38–0.68).
Effect modification by BMI category was not statistically significant (p-interaction = 0.49), showing similar risk reductions in patients with BMI <30 and 30–39.9 kg/m².
In Class III obesity (BMI ≥40 kg/m²), the point estimate shifted toward the null and was imprecise, meaning clinically important attenuation could not be excluded.

Study Design

Type

Case-Control (n=1,854)

Multicenter

Yes

Structured PICO

Does dabigatran use reduce incident ischaemic stroke or transient ischaemic attack in patients with atrial fibrillation across different BMI categories?

Population

Exposure

Dabigatran use

Comparator

No dabigatran use

Outcome

Incident ischaemic stroke (IS) or transient ischaemic attack (TIA)hard clinical

Main Result

Odds Ratio: 0.5 (95% CI 0.38–0.68)

p-value: p=<0.001

Limitations

Case-control design precludes causal inference and residual confounding cannot be excluded.
Adherence derived from dispensing data may not fully reflect actual medication use.
Limited statistical power in patients with Class III obesity (BMI ≥40 kg/m2) due to small sample size.
BMI does not fully capture adiposity or fat distribution and may misclassify risk across ethnic groups.
Use of non-anticoagulated patients as the reference group may introduce confounding by indication and healthy-user or frailty-related bias.
Could not distinguish new users from prevalent users due to lack of historical dispensing data.
Limited power in patients with BMI ≥40 kg/m2
Clinically important attenuation in Class III obesity could not be excluded

Cite This Study

synapsesocial.com/papers/6a9fd82058e84d0ff5b47698 https://doi.org/10.1007/s11239-026-03394-1

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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