■在非瓣膜性心房颤动(AF)和静脉血栓栓塞(VTE)的治疗中,直接口服抗凝剂(DOAC)已超过华法林。有限的数据探索DOAC在肥胖中的安全性。
■这项2015年6月至2019年9月的多中心回顾性研究使用密歇根抗凝质量改善计划(MAQI2)注册表,比较了不同体重类别的DOAC和华法林(非肥胖:体重指数(BMI)18.5和<30;肥胖:BMI30和<40;严重肥胖:BMI40)。主要成果包括主要成果,临床相关非主要(CRNM),和每100例患者年的轻微出血事件。次要结果包括中风,复发性VTE,和全因死亡率。
■对4089例房颤患者中的49%和3162例VTE患者中的46%开DOAC。与接受华法林治疗的患者相比,无论适应症如何,接受DOAC治疗的患者在所有BMI类别中估计的肾小球滤过率都较高.在AF人群中,接受DOAC治疗的严重肥胖患者的严重程度更高(3.4vs1.8,p=0.004),CRNM(8.6vs5.9,p=0.019),和少量出血(11.4vs9.9,p=0.001)。卒中或全因死亡率无差异。在VTE人群中,在接受DOAC治疗的患者中,CRNM(7.5vs6.7,p=0.042)和少量出血(19.3vs10.5,p<0.001)事件发生率较高.肺栓塞复发无差异,中风,或全因死亡率。
■与华法林相比,使用DOACs治疗的严重肥胖VTE和AF患者的出血率更高。次要结果没有差异。需要进一步的研究来比较抗凝剂类别并了解该人群的出血驱动因素。
UNASSIGNED: Direct oral anticoagulants (DOACs) have overtaken warfarin in the treatment of nonvalvular atrial fibrillation (AF) and venous thromboembolism (VTE). Limited data explore the safety of DOACs in obesity.
UNASSIGNED: This multicenter retrospective study between June 2015 and September 2019 uses the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry to compare DOACs and warfarin across weight classes (not obese: body mass index (BMI) ⩾ 18.5 and < 30; obese: BMI ⩾ 30 and < 40; severely obese: BMI ⩾ 40). Primary outcomes include major, clinically relevant nonmajor (CRNM), and minor bleeding events per 100 patient-years. Secondary outcomes include stroke, recurrent VTE, and all-cause mortality.
UNASSIGNED: DOACs were prescribed to 49% of the 4089 patients with AF and 46% of the 3162 patients with VTE. Compared to patients treated with warfarin, those treated with DOACs had a higher estimated glomerular filtration rate across BMI categories regardless of indication. In the AF population, severely obese patients treated with DOACs had more major (3.4 vs 1.8, p = 0.004), CRNM (8.6 vs 5.9, p = 0.019), and minor bleeding (11.4 vs 9.9, p = 0.001). There was no difference in stroke or all-cause mortality. In the VTE population, both CRNM (7.5 vs 6.7, p = 0.042) and minor bleeding (19.3 vs 10.5, p < 0.001) events occurred at higher rates in patients treated with DOACs. There was no difference in recurrent pulmonary embolism, stroke, or all-cause mortality.
UNASSIGNED: There is a higher rate of bleeding in severely obese patients with VTE and AF treated with DOACs compared to warfarin, without a difference in secondary outcomes. Further studies to compare the anticoagulant classes and understand bleeding drivers in this population are needed.