EFFICACY AND SAFETY OF DIRECT ORAL ANTICOAGULANTS (DOACS) IN MORBIDLY OBESE PATIENTS

Abstract

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: There is a paucity of clinical data evaluating anticoagulation with the direct oral anticoagulants (DOACs) in morbidly obese patients. We sought to examine the efficacy and safety of the DOACs, apixaban, dabigatran, and rivaroxaban, in comparison to warfarin as determined by the frequency of thromboembolic and major bleeding events in patients with either a body-mass index (BMI) over 40 kg/m2 and/or a weight over 120 kg. METHODS: After approval from IRB, we collected retrospective data from our institution’s records on 180 patients. We analyzed the rates of ischemic stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), myocardial infarction (MI), and major bleeding in morbidly obese patients receiving apixaban, dabigatran, or rivaroxaban in comparison to warfarin for anticoagulation due to nonvalvular atrial fibrillation, postoperative thrombus prophylaxis, or DVT/PE treatment and/or reduction in risk for recurrence. RESULTS: An interim analysis included 90 patients in both arms. Approximately 52% (n=41) of patients in the DOAC group were on apixaban therapy, 12% (n=11) on dabigatran, and 37% (n=33) on rivaroxaban. Patients in the DOAC group were analyzed an average of 30,151 days after initiating therapy. Around 20% of patients in the DOAC group were also on antiplatelet therapy. The average BMI and weight in the DOAC group were 46.7 kg/m2 and 139.3 kg, respectively. In the warfarin group, average BMI and weight were 45.8 kg/m2 and 135.9 kg, respectively. There were a total of 11 ischemic stroke and systemic embolic events in the DOAC group and 10 in the warfarin group (OR: 1.11, 95% CI 0.45-2.78; p=0.82). The events in the DOAC group consisted of 3 patients who developed ischemic stroke, 3 patients who developed DVTs, 1 who developed a PE, and 4 patients who developed MIs. In the warfarin group, the events consisted of 3 patients who developed ischemic stroke, 2 patients who developed DVTs, 2 who developed PEs, and 3 patients who developed MIs. There were 2 major bleeding events in the DOAC group and 3 events in the warfarin group (p=0.65). CONCLUSIONS: Anticoagulation therapy with DOACs in morbidly obese patients appears to be a safe and effective treatment strategy for prevention of thromboembolic events. Larger studies are necessary to confirm these findings. CLINICAL IMPLICATIONS: This is a hypothesis-generating study demonstrating that apixaban, dabigatran, and rivaroxaban may be safe and effective anticoagulants in morbidly obese patients. DISCLOSURES: Speaker/Speaker's Bureau relationship with Speaker for Janssen, sanofi and Regeneron Please note: $1001 - $5000 Added 03/11/2018 by Thomas Alexander, source=Web Response, value=Honoraria No relevant relationships by elizabeth awudi henry, source=Web Response No relevant relationships by Charlene Kalani, source=Web Response Speaker/Speaker's Bureau relationship with Sunovian Please note: $5001 - $20000 Added 11/20/2017 by Salim Surani, source=Web Response, value=Honoraria Advisory Committee Member relationship with Astra Zeneca Please note: $5001 - $20000 Added 11/20/2017 by Salim Surani, source=Web Response, value=Consulting fee No relevant relationships by George Udeani, source=Web Response