Patients with higher body mass index treated with direct / novel oral anticoagulants (DOAC / NOAC) for atrial fibrillation experience worse clinical outcomes

Body Mass Index Influence on the Clinical Outcomes for Nonvalvular Atrial Fibrillation Patients Admitted to a Hospital Treated with Direct Oral Anticoagulants: A Retrospective Cohort Study

“… 16 Some real-word studies suggested no indication that elevated BMI is associated with a lack of DOAC effectiveness or safety, 17–19 while one retrospective study indicated that patients with higher BMI treated with DOAC experienced worse clinical outcomes. 6 Our results showed partly similar clinical outcomes with the retrospective study, suggesting that patients with higher BMI could be significantly prone to encounter thrombotic incidents during anticoagulation with lower dose DOACs, especially for stroke events. 6 Metabolic disturbances may play an important role in the development of stroke, and moreover, the duration of diabetes mellitus was a significant cofactor, representing a dose–response relationship of diabetes mellitus exposure to stroke severity.…”

“… 6 Our results showed partly similar clinical outcomes with the retrospective study, suggesting that patients with higher BMI could be significantly prone to encounter thrombotic incidents during anticoagulation with lower dose DOACs, especially for stroke events. 6 Metabolic disturbances may play an important role in the development of stroke, and moreover, the duration of diabetes mellitus was a significant cofactor, representing a dose–response relationship of diabetes mellitus exposure to stroke severity. 20 …”

“… 23 Recent data implied that patients with higher BMI and receiving factor Xa inhibitors were more likely to experience stroke/systemic embolism sooner. 6 …”

Closure Device-Related Thrombosis After Anticoagulation With Dabigatran in Patients Undergoing Percutaneous Left Atrial Appendage Closure: Case Reports and Literature Review

“…BMI of >25 was the cut-off point according to the World Health Organization for obesity (Haschke et al, 2016). This might lead to a reduction in the anti-thrombosis effect of dabigatran and an increase in the incidence of DRT (Lucijanic et al, 2020). One probable explanation for our four cases with closure device-related thrombosis anticoagulated with dabigatran was the suboptimal drug dosage levels which potentially increased the risk of thrombosis.…”

Direct Oral Anticoagulants in Atrial Fibrillation: Practical Considerations and Remaining Issues

“…Although DOAC labels only reflect on low-body-weight patients (necessitating DOAC dose reduction for apixaban, edoxaban, and dabigatran), there is widespread concern that the fixed dosing may carry a risk of relative underexposure in extreme obesity [35][36][37] and, in 2016, the International Society on Thrombosis and Haemostasis (ISTH) Scientific and Standardization Committee issued a warning against the use of fixed-dose DOACs in patients with a body mass index (BMI) of >40 kg/m 2 or a weight of >120 kg, based on lack of evidence for patients at the upper extreme of weight. 38 However, subgroup analyses in large phase III trials suggest that DOACs are efficacious and well tolerated in obese patients, although the respective patient numbers were low.…”