Effectiveness and Safety of Dabigatran in Atrial Fibrillation Patients with Severe Obesity: a Real-World Retrospective Cohort Study

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2021 Sep 21

PMID 34545470

Citations 3

Authors

Cheng-Wei Huang

Lewei Duan

Jaejin An

John J Sim

Ming-Sum Lee

Affiliations

Soon will be listed here.

Abstract

Background: Direct oral anticoagulants such as dabigatran are the preferred anticoagulant in treating atrial fibrillation (AF) patients due to their effectiveness and safety. Whether this applies to severely obese patients needs to be determined.

Objective: To compare the effectiveness and safety of dabigatran with warfarin among AF patients with severe obesity.

Design: Retrospective cohort study.

Participants: AF patients with a BMI >40kg/m or a weight >120kg receiving dabigatran or warfarin between 10/01/2010 and 12/31/2019 in a large integrated health system and followed through 08/01/2020.

Interventions: Not applicable.

Main Measures: Primary effectiveness outcome was composite thromboembolism including transient ischemic attack, ischemic stroke, or systemic embolism. Primary safety outcome was composite bleeding including gastrointestinal bleeding, intracranial bleeding, or other bleeding. Secondary outcomes included the individual outcomes and all-cause mortality. Propensity score matching (PSM) was performed to create a 1:1 matched cohort and Cox proportional hazards model was used to estimate the hazard ratio (HR) of each outcome for dabigatran users compared to warfarin users.

Key Results: A total of 6848 patients receiving either dabigatran or warfarin were identified. In a 1:1 matched cohort, dabigatran users had a HR of 0.71 (95% confidence interval (CI): 0.56-0.91) for composite thromboembolism, a HR of 1.24 (95%CI: 1.07-1.42) for composite bleeding, and a HR of 0.57 (95% CI: 0.45-0.71) for all-cause mortality when compared to warfarin users.

Conclusions: Among AF patients with a BMI >40kg/m or a weight >120kg in a real-world clinical setting, dabigatran was effective in reducing the risk of thromboembolism and mortality but was associated with an increased risk of bleeding when compared to warfarin. Dabigatran may be a reasonable option for AF patients with severe obesity.

Citing Articles

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

Adelkhanova A, Oli P, Shrestha D, Shtembari J, Jha V, Shantha G Health Sci Rep. 2024; 7(4):e2044.

PMID: 38650729 PMC: 11033493. DOI: 10.1002/hsr2.2044.

The safety and efficacy of nonvitamin K antagonist oral anticoagulants in morbidly obese patients with atrial fibrillation: a meta-analysis.

Elfar S, Mahmoud S, Hamdi S, Emad A, Abd-ElGawad M, Taha N BMC Cardiovasc Disord. 2024; 24(1):74.

PMID: 38279126 PMC: 10811832. DOI: 10.1186/s12872-024-03731-3.

Pharmacokinetics and Dosing Regimens of Direct Oral Anticoagulants in Morbidly Obese Patients: An Updated Literature Review.

Zhao Y, Guo M, Li D, Xu W, Pan C, He C Clin Appl Thromb Hemost. 2023; 29:10760296231153638.

PMID: 36760080 PMC: 9943962. DOI: 10.1177/10760296231153638.

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