Efficacy and safety of direct oral factor Xa inhibitors compared with warfarin in patients with morbid obesity: a single-centre, retrospective analysis of chart data

Kushnir, Margarita; Choi, Yun Young; Eisenberg, Ruth; Rao, Devika; Tolu, Seda; Gao, Jingyang; Mowrey, Wenzhu; Billett, Henny H.

doi:10.1016/s2352-3026(19)30086-9

Cited by 114 publications

(136 citation statements)

References 28 publications

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“…Our use of codes for DVT and PE events is supported by a prior review that found high positive predictive values (65–95%) for identifying VTE events . Our VTE recurrence rates were higher (~6%) than those reported in one study (1–2%) but less than half the rates observed by another report (16–17%) . These differences may be attributed primarily due to the study designs and sources of data.…”

Section: Discussionsupporting

confidence: 74%

“…Our major bleeding definition used a validated algorithm and was consistent with the approach used by others . Our bleeding event rates were similar to those reported by each of the prior studies (~1–2%) …”

Section: Discussionsupporting

confidence: 74%

“…We found no significant difference in VTE recurrence between groups regardless of treatment acuity, thus providing insight on differences in patient populations at varying thrombotic risks. Prior studies only included those who were newly started on anticoagulation . With regard to safety, we found no significant difference in bleeding between treatment groups.…”

Section: Discussionmentioning

confidence: 63%

“…A single-center retrospective study evaluated patients with a BMI of 40 kg/m 2 or higher who newly initiated apixaban, rivaroxaban, or warfarin for treatment of either VTE or atrial fibrillation. 20 A total of 366 patients (47 on apixaban, 152 on rivaroxaban, and 167 on warfarin) were treated for VTE; in this subgroup, the incidence of recurrent VTE was not significantly different between groups (2.1%, 2%, and 1.2% for the apixaban, rivaroxaban, and warfarin groups, respectively; p=0.74). The incidence of major bleeding also did not significantly differ among the groups (2.1%, 1.3%, and 2.4% for the apixaban, rivaroxaban, and warfarin groups, respectively; p=0.77).…”

Section: Discussionmentioning

confidence: 92%

“…Our study adds to the limited body of literature on this controversial topic. A single‐center retrospective study evaluated patients with a BMI of 40 kg/m 2 or higher who newly initiated apixaban, rivaroxaban, or warfarin for treatment of either VTE or atrial fibrillation . A total of 366 patients (47 on apixaban, 152 on rivaroxaban, and 167 on warfarin) were treated for VTE; in this subgroup, the incidence of recurrent VTE was not significantly different between groups (2.1%, 2%, and 1.2% for the apixaban, rivaroxaban, and warfarin groups, respectively; p=0.74).…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

et al. 2020

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Study Objective Studies on the use of direct oral anticoagulants (DOACs) in obese patients are limited. Current guidelines advise against DOAC use in patients with a body weight more than 120 kg or body mass index higher than 40 kg/m2. Therefore, the aim of this study was to evaluate the effectiveness and safety of DOACs versus warfarin for the treatment of acute venous thromboembolism (VTE) in obese patients. Design Retrospective matched cohort study. Setting Integrated delivery system of 40 academic, community, and specialty hospitals. Patients A total of 1840 adults with a primary admission diagnosis of acute VTE who received a DOAC (apixaban, dabigatran, or rivaroxaban [632 patients] or warfarin [1208 patients]) while hospitalized between January 1, 2011, and October 1, 2015, and who had a body weight more than 100 kg and less than 300 kg, were included. Patients in the warfarin group were matched in a 2:1 ratio to patients who received a DOAC based on history of VTE, chronic kidney disease, race, and age. Measurements and Main Results The primary outcome was recurrence of VTE within 12 months of the index admission date. Secondary outcomes included occurrence of pulmonary embolism (PE) and deep vein thrombosis (DVT) events separately within the study time frame, as well as bleeding within 12 months of the index admission date. No significant difference in the recurrence of VTE was observed between patients who received a DOAC compared with those who received warfarin (6.5% vs 6.4%, p=0.93). Likewise, no significant differences in the occurrence of PE and DVT were seen between the DOAC‐ and warfarin‐treated patients (3.7% vs 3.8%, p=0.94, and 3% vs 3.5%, p=0.56, respectively). Bleeding occurred in 1.7% and 1.2% of patients in the DOAC and warfarin groups, respectively (p=0.31). Conclusion To our knowledge, this is the largest clinical study to date showing that patients with obesity can be treated effectively and safely with a DOAC compared with warfarin for acute VTE. Thus DOACs should be considered a reasonable alternative to warfarin for treatment of acute VTE in obese patients.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

et al. 2020

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Safety and efficacy of direct oral anticoagulants in comparison to warfarin in obese patients with atrial fibrillation: A systematic review and meta‐analysis

Adelkhanova,

Oli,

Shrestha

et al. 2024

Health Science Reports

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Background and AimObesity 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.MethodsThe 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.ResultsTwo 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).ConclusionBased 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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Comparing direct oral anticoagulants and vitamin K antagonist use in morbidly obese patients with venous thromboembolism: A single center retrospective cohort study

Scott

Cafuir

et al. 2022

eJHaem

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Introduction: Limited data exists on the safety and efficacy of direct‐acting oral anticoagulants (DOAC) use in morbidly obese patients with venous thromboembolism (VTE). Given the benefits of DOAC use over vitamin K antagonists (VKAs), in terms of monitoring requirements, and dietary and drug interactions, it is important to evaluate whether this is consistent in the higher risk for VTE recurrence morbidly obese group body mass index (BMI ≥ 40 kg/m2). Materials and methods: This retrospective, single‐center cohort study included patients with a BMI of at least 40 kg/m2 who were admitted to Emory University Hospital from 1st January 2012 to 31st May 2020 with acute VTE, and subsequently initiated on anticoagulation treatment with either DOAC or VKA (warfarin). Univariate and bivariate analyses were used to evaluate differences in demographics by treatment type and BMI. Multivariate Cox proportional hazard regression was used to assess the risk of VTE recurrence by type of treatment among morbidly obese patient subgroup. Results: There were 247 (11.8%) morbidly obese (≥ 40 kg/m2) patients who were more likely than non‐obese patients to be younger, female, and of non‐white race. Thirty percent of the study population (n=74) had a BMI >50 kg/m2. T ime‐to‐event analysis confirmed that the hazard of experiencing a recurrent thrombosis was not statistically significantly different among morbidly obese patients treated with a DOAC compared with VKA (hazard ratio [HR]: 0.28, confidence interval [CI] 0.07‐1.11, p = 0.07). Conclusions: This study aligns with previous literature and confirms that morbidly obese patients receiving DOAC or VKA have similar risks of recurrent VTE.

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Efficacy and safety of direct oral factor Xa inhibitors compared with warfarin in patients with morbid obesity: a single-centre, retrospective analysis of chart data

Cited by 114 publications

References 28 publications

Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

Safety and efficacy of direct oral anticoagulants in comparison to warfarin in obese patients with atrial fibrillation: A systematic review and meta‐analysis

Comparing direct oral anticoagulants and vitamin K antagonist use in morbidly obese patients with venous thromboembolism: A single center retrospective cohort study

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