Abstract
Obesity plays an essential role in the safety of pharmacologic drugs. There is paucity of data for direct oral anticoagulants (DOACs) in the obese, despite these agents becoming more widely used. The primary and secondary objectives of this study were to assess the safety and efficacy of DOACs in the overweight and obese populations when used for primary prophylaxis in the setting of non-valvular atrial fibrillation (NVAF) and for treatment of venous thromboembolisms (VTE). We conducted a retrospective cohort study in a large tertiary care center and obtained data through review of electronic health records. Among patients with NVAF and VTE on apixaban, there were no differences in rates of major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) in the overweight and obese populations when compared to normal weight and underweight individuals. The multivariate adjusted analysis for rivaroxaban found that the odds of CRNMB for patients with BMI <25 was 5.37 (95% CI 1.50–19.32) times higher than that of BMI ≥25. Moreover, patients on medications that had known interactions with DOACs had 6.40 times higher odds of CRNMB than patients without such interactions (95% CI 1.49–27.57), which was not accounted for by the effects of aspirin and plavix alone. Efficacy was similar between all weight groups, for both apixaban and rivaroxaban. These results support previous analyses preformed in the large phase III trials and confirm that apixaban and rivaroxaban are safe in the overweight and obese.
Highlights
Obesity is a major healthcare challenge that is estimated to escalate to a global epidemic in the following years [1].erefore, it is essential to assess the healthcare needs of this population in terms of pharmacologic modifications required for this subset to provide effective treatment and prevent adverse events
1.50–19.31 0.98–1.07 0.23–2.41 0.17–1.74 0.80–1.15 1.49–27.57 0.14–2.04 0.44–630.68 0.03–1.18 is table presents the multivariate logistical regression model for rivaroxaban and odds ratios for outcome of Clinically relevant nonmajor bleeding (CRNMB) in overweight patients compared to normal weight controls in the NVAF cohort
Our study provides further evidence of comparable efficacy and safety of apixaban and rivaroxaban in the obese patients with AF and venous thromboembolism (VTE)
Summary
Obesity is a major healthcare challenge that is estimated to escalate to a global epidemic in the following years [1].erefore, it is essential to assess the healthcare needs of this population in terms of pharmacologic modifications required for this subset to provide effective treatment and prevent adverse events. Subgroup analyses in various randomized clinical trials have evaluated the efficacy and safety measures in obese patients and showed no differences in efficacy compared to conventional VKAs or enoxaparin. There have been no dedicated large prospective randomized control trials to address the use of DOAC in the obese. Despite limited data, these agents are being used in clinical practice in the real world population [8,9,10,11,12,13, 15,16,17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
