Increased risk of major bleeding in underweight patients with atrial fibrillation who were prescribed non-vitamin K antagonist oral anticoagulants

Impact of body mass index on real-world outcomes of rivaroxaban treatment in Japanese patients with non-valvular atrial fibrillation

“…Data from the present study demonstrated no significant association between BMI and the incidence of thromboembolism, which is consistent with results from previous studies [6,7]. However, a significantly higher incidence of stroke/non-CNS SE/MI was observed in patients who were underweight than in those of normal weight, which may be partially explained by differences in demographic characteristics between BMI groups.…”

“…Similar results were reported in the J-RHYTHM registry sub-analysis, which showed a trend towards increasing rates of major hemorrhage with decreasing BMI, but that being underweight was not associated with a significantly increased risk of hemorrhage compared with patients of normal weight [6]. However, Park et al demonstrated that patients who were underweight had a significantly increased risk of major bleeding compared with those of normal weight [7]. These inconsistencies may be due to differences in study design (e.g.…”

“…The key findings of this study in Japanese patients with NVAF receiving rivaroxaban can be summarized as follows: first, baseline characteristics varied across BMI categories; second, the incidences of stroke/non-CNS SE/MI and all-cause mortality were significantly higher in those who were underweight than in those of normal weight; third, none of the BMI categories emerged as an independent predictor of major bleeding or stroke/ non-CNS SE/MI; fourth, in multivariable analyses, being underweight was found to be an independent predictor of all-cause mortality. Limited conclusions could be drawn from previous global studies investigating the impact of BMI on outcomes in patients with AF receiving anticoagulants because very few patients included in these analyses were underweight [7,[12][13][14]. The efficacy and safety of rivaroxaban in patients with NVAF were established in the global Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) and Japan-specific J-ROCKET AF phase 3 studies [15,16].…”

“…Moreover, many trials do not consider differences in body composition; for example, Western patients tend to be taller and have higher body weight than Asian patients. A recent meta-analysis, which included Asian patients, demonstrated that being underweight was associated with an increased risk of stroke or systemic embolism (SE) [5]; however, other studies showed no associations between being underweight and the incidence of thromboembolism [6,7]. These inconsistent data suggest a need to further examine the impact of BMI on outcomes in patients being treated for stroke prevention in AF.…”

Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation

“…Therefore, a low BMI and malnutrition are important considerations in elderly populations taking medications due to the potential for an altered drug metabolism. A retrospective study conducted in Korea reported that having a low BMI (<18.5 kg/m 2 ) was significantly associated with an increased risk of major bleeding compared to having a normal weight or being overweight to obese in AF patients receiving DOACs [17]. Our study also showed that the patients who had a low BMI had more bleeding events than those that did not despite an appropriate dose of OACs in accordance with the approved recommendations.…”