Abstract 17177: Safety and Efficacy of Direct Oral Anticoagulants in Comparison to Warfarin in Obese Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Introduction: Obesity affects nearly 650 million adults worldwide and the prevalence of obesity has been steadily increasing. Obesity has adverse effects on cardiovascular health, increasing the risk for developing hypertension, coronary artery disease, heart failure and atrial fibrillation (AF). It is well known that anticoagulation is warranted in patients with AF, however the safety and efficacy of direct oral anti-coagulant (DOAC) over vitamin K antagonist (VKA) are not well explored in the obese population. This meta-analysis aimed to compare DOAC to VKA in obese populations with AF. Methods: The PRISMA guidelines were followed for this meta-analysis, and it was registered in PROSPERO (CRD42023392711). PubMed, Medline, Embase, Cochrane Library and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened title and abstract, followed by full text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as effect measure. Results: 2259 studies were identified from the database search and 19 studies were included in the analysis. There were significantly lesser odds of ischemic (OR 0.71, 95% CI 0.66-0.75) and hemorrhagic stroke (OR 0.47, 95% CI 0.35-0.62) in the DOAC group compared to VKA group. There were also lower odds for occurrence of systemic embolism (OR 0.67, 95% CI 0.54-0.83) and major bleeding (OR 0.62, 95% CI 0.54-0.72) in the DOAC group. Conclusions: Based on this meta-analysis it can be concluded that DOACs are safer and more efficacious than vitamin K antagonists in the obese population with AF.