Low Body Weight Increases the Risk of Ischemic Stroke and Major Bleeding in Atrial Fibrillation: The COOL-AF Registry.

Rungroj Krittayaphong,Sakaorat Kornbongkotmas,Gregory Y H Lip,Chulalak Komoltri,Ahthit Yindeengam,Ply Chichareon

doi:10.3390/jcm9092713

Abstract

We aimed to determine if low body weight (LBW) status (<50 kg) is independently associated with increased risk of ischemic stroke and bleeding in Thai patients with non-valvular atrial fibrillation (NVAF). (1) Background: It has been unclear whether LBW influence clinical outcome of patients with NVAF. (2) Methods: This prospective multicenter cohort study included patients enrolled in the COOL-AF Registry. The following data were collected: demographic data, medical history, risk factors and comorbid conditions, laboratory and investigation data, and medications. Follow-up data were collected every 6 months. Clinical events during follow-up were confirmed by the adjudication committee. (3) Results: A total of 3367 patients were enrolled. The mean age was 67.2 ± 11.2 years. LBW was present in 338 patients (11.3%). Anticoagulant and antiplatelet was prescribed in 75.3% and 26.2% of patients, respectively. Ischemic stroke, major bleeding, intracerebral hemorrhage (ICH), and death occurred during follow-up in 2.9%, 4.4%, 1.4%, and 7.7% of patients, respectively, during 25.7 months follow-up. LBW was an independent predictor of ischemic stroke, major bleeding, ICH, and death, with a hazard ratio of 2.40, 1.79, 2.37, and 2.65, respectively. (4) Conclusions: LBW was independently associated with increased risk of adverse outcomes in Thai patients with NVAF. This should be carefully considered when balancing the risks and benefits of stroke prevention among patients with different body weights.

Highlights

Non-valvular atrial fibrillation (NVAF) can lead to the development of thromboembolism and subsequent ischemic stroke [1]
Given that many Thai patients are of low body weight (LBW), the aim of this study was to determine if LBW status (
The results showed that LBW remained a significant predictor for clinical outcomes, with the adjusted hazard ratio (HR) for showed that LBW remained a significant predictor for clinical outcomes, with the adjusted HR for LBW for ischemic stroke/transient ischemic attack (TIA), major bleeding, intracerebral hemorrhage (ICH), and death being 2.64 (1.63–4.27), p < 0.001; 2.47 (1.56–3.91), p < 0.001; 3.19 (1.55–6.58), p = 0.002; and 2.47 (1.83–3.35), p < 0.001, respectively

Summary

Introduction

Non-valvular atrial fibrillation (NVAF) can lead to the development of thromboembolism and subsequent ischemic stroke [1]. Of note, being of low body weight (LBW) might increase stroke risk in both white European [11] and Asian populations [12]. LBW increases the risk of bleeding, especially among those who are on OAC [12] In those taking vitamin K antagonist (e.g., warfarin), the dose of warfarin to achieve the target international normalized ratio (INR) may be lower in LBW patients due to a smaller volume of drug distribution; the likelihood of the development of complications after drug dose adjustment was reported to be higher in LBW patients [13]. Dose adjustment of certain non-vitamin K antagonist oral anticoagulants (NOACs) is recommended in patients with a lower body weight [14]

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Conclusion