Abstract
This ARISTOPHANES analysis examined stroke/systemic embolism (SE) and major bleeding (MB) among a subgroup of nonvalvular atrial fibrillation (NVAF) patients with obesity prescribed warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) in order to inform clinical decision making. A retrospective observational study was conducted among NVAF patients who were obese and initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013–30 September 2015, with data pooled from CMS Medicare and four US commercial claims databases. Propensity score matching was completed between NOACs and against warfarin in each database, and the results were pooled. Cox models were used to evaluate the risks of stroke/SE and MB. A total of 88,461 patients with obesity were included in the study. Apixaban and rivaroxaban were associated with a lower risk of stroke/SE vs. warfarin (HR: 0.63, 95% CI: 0.49–0.82 and HR: 0.84, 95% CI: 0.72–0.98). Dabigatran was associated with a similar risk of stroke/SE compared to warfarin. Compared with warfarin, apixaban and dabigatran had a lower risk of MB (HR: 0.54, 95% CI: 0.49–0.61 and HR: 0.75, 95% CI: 0.63–0.91). Rivaroxaban was associated with a similar risk of MB compared to warfarin. In this high-risk population with obesity, NOACs had a varying risk of stroke/SE and MB vs. warfarin.
Highlights
Atrial fibrillation (AF) is the most common type of arrhythmia in the USA and European countries, with a current estimated prevalence between 1% and 4% [1]
With Centers for Medicare & Medicaid Services (CMS) Medicare and four large US national claims datasets, this study found that non-vitamin K antagonist oral anticoagulants (NOACs) had a varying risk of stroke/systemic embolism (SE) and major bleeding (MB) compared to warfarin and among each other in this population with obesity
In our dose subgroup analysis, we found that standard dose apixaban and rivaroxaban were associated with a lower risk of stroke/SE compared to warfarin, and standard-dose apixaban and dabigatran were associated with a lower risk of MB compared to warfarin
Summary
Atrial fibrillation (AF) is the most common type of arrhythmia in the USA and European countries, with a current estimated prevalence between 1% and 4% [1]. Its prevalence is of critical concern owing to its cardiovascular complications such as ischemic stroke, heart failure, and increasing mortality [2]. Obesity has been linked with AF, due to its association with obstructive sleep apnea, diabetes mellitus, hypertension, left ventricular dysfunction, heart failure with preserved left ventricular function, and left atrial enlargement [4,5,6]. It has been associated with hypofibrinolysis, inflammation, and a prothrombotic state, further bolstering the link with the thromboembolic effects of AF [4,5]
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