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Efficacy and safety of direct oral anticoagulant in morbidly obese patients with atrial fibrillation: systematic review and meta-analysis.

Authors
  • Thangjui, Sittinun1
  • Kewcharoen, Jakrin2
  • Yodsuwan, Ratdanai1
  • Trongtorsak, Angkawipa3
  • Thyagaturu, Harshith1
  • Shrestha, Bishesh1
  • Winans, Amanda R M4
  • Bischof, Edward5
  • 1 Internal Medicine Residency Program, Bassett Healthcare Network, 1 Atwell Rd, Cooperstown, NY 13326, USA.
  • 2 Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA.
  • 3 Internal Medicine Residency Program, Amita Health Saint Francis Hospital, Evaston, IL, USA.
  • 4 Section of Clinical Pharmacy, Department of Pharmaceutical Care Services, Bassett Healthcare Network, Cooperstown, NY, USA.
  • 5 Department of Internal Medicine, Bassett Healthcare Network, Cooperstown, NY, USA.
Type
Published Article
Journal
European heart journal. Cardiovascular pharmacotherapy
Publication Date
Jun 08, 2022
Volume
8
Issue
4
Pages
325–335
Identifiers
DOI: 10.1093/ehjcvp/pvab026
PMID: 33730164
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We conducted a systematic review and meta-analysis on three outcomes. We assessed the efficacy and safety of direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) in morbidly obese patients with atrial fibrillation (AF). We compared the efficacy and safety of DOAC in obese patients and non-obese patients with AF. Finally, we updated the current knowledge of outcomes of AF patients with obesity compared with normal-weight patients regardless of anticoagulation type. Using PubMed and Embase, we searched for literature published from inception to August 2020 for studies conducted in morbidly obese patients with AF who used DOACs and/or VKA for stroke or systemic embolism (stroke/SE) prevention that report efficacy and/or safety data. GRADE assessment was performed to determine the quality of the meta-analysis results. Direct oral anticoagulant was not statistically different from VKA in reducing stroke/SE with relative risk (RR) of 0.85 [95% confidence interval (CI): 0.56-1.29; very low certainty evidence]. Major bleeding risk was lower in the DOAC groups with RR of 0.62 (95% CI: 0.48-0.80; low certainty evidence). Obese patients with AF who used DOACs had lower risk of stroke/SE and similar major bleeding risk compared to non-obese patients with RR of 0.77 (95% CI: 0.70-0.84; low certainty evidence) and 1.02 (95% CI: 0.94-1.09; low certainty evidence), respectively. Obese patients with AF who used any type of anticoagulant had lower risk of stroke/SE compared to normal-weight patients with RR of 0.62 (95% CI: 0.57-0.69; low certainty evidence). The use of DOACs in morbidly obese patients may be reasonable if needed, and more dedicated studies are needed to make a more robust recommendation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

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