Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide and the main cause of anticoagulation, being direct oral anticoagulants (DOAC) increasingly used in this context. On the other hand, obesity is a known risk thromboembolic factor. In the clinical trials that led to the a...

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Autores principales:	Begoña Navarro-Almenzar, Juan José Cerezo-Manchado, Faustino García-Candel
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Atrial fibrillation Morbid obesity Anticoagulants Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5274eafe0753478e89c4e78210c8dacd
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spelling	oai:doaj.org-article:5274eafe0753478e89c4e78210c8dacd2021-11-12T04:42:05ZReal life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity2352-906710.1016/j.ijcha.2021.100913https://doaj.org/article/5274eafe0753478e89c4e78210c8dacd2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352906721002013https://doaj.org/toc/2352-9067Background: Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide and the main cause of anticoagulation, being direct oral anticoagulants (DOAC) increasingly used in this context. On the other hand, obesity is a known risk thromboembolic factor. In the clinical trials that led to the approval of DOAC for ischemic stroke prevention, patients with morbid obesity were underrepresented. The International Society of Thrombosis and Haemostasis suggests not using these drugs in morbid obese patients. Thus, the primary objectives of this study were to analyse the rates of mortality, thrombotic and haemorrhagic events in patients with morbid obesity. As secondary objectives, factors statistically associated with these events were analysed. Methods: multicentre retrospective study that included patients diagnosed with AF on treatment with DOAC from January 2013 to December 2016. The subgroup of patients with morbid obesity (BMI > 40 and / or weight > 120 kg) was analysed. Mean follow-up was 1.7 years. Results: Amongst 2,492 patients included in the study, 135 patients had morbid obesity (mean age was 71 ± 11 years). The mean scores of the CHA2DS2-VASc and HAS-BLED risk scales were 3.7 ± 1.6 and 2.2 ± 0.9, respectively. Neither differences were found regarding mortality (5.2 vs 6/100 patient-years, p = 0.662), ischemic stroke (0.8 vs 1.9/100 patient-years, p = 0.261) and major bleeding rates (3 vs 3.1/100 patient-years, p = 0.983) between morbidly obese population and general population. Nor was there an association found between the degree of obesity and any of the events studied. Conclusion: DOAC are safe and effective in morbidly obese patients.Begoña Navarro-AlmenzarJuan José Cerezo-ManchadoFaustino García-CandelElsevierarticleAtrial fibrillationMorbid obesityAnticoagulantsDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology: Heart & Vasculature, Vol 37, Iss , Pp 100913- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Atrial fibrillation Morbid obesity Anticoagulants Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Atrial fibrillation Morbid obesity Anticoagulants Diseases of the circulatory (Cardiovascular) system RC666-701 Begoña Navarro-Almenzar Juan José Cerezo-Manchado Faustino García-Candel Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity
description	Background: Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide and the main cause of anticoagulation, being direct oral anticoagulants (DOAC) increasingly used in this context. On the other hand, obesity is a known risk thromboembolic factor. In the clinical trials that led to the approval of DOAC for ischemic stroke prevention, patients with morbid obesity were underrepresented. The International Society of Thrombosis and Haemostasis suggests not using these drugs in morbid obese patients. Thus, the primary objectives of this study were to analyse the rates of mortality, thrombotic and haemorrhagic events in patients with morbid obesity. As secondary objectives, factors statistically associated with these events were analysed. Methods: multicentre retrospective study that included patients diagnosed with AF on treatment with DOAC from January 2013 to December 2016. The subgroup of patients with morbid obesity (BMI > 40 and / or weight > 120 kg) was analysed. Mean follow-up was 1.7 years. Results: Amongst 2,492 patients included in the study, 135 patients had morbid obesity (mean age was 71 ± 11 years). The mean scores of the CHA2DS2-VASc and HAS-BLED risk scales were 3.7 ± 1.6 and 2.2 ± 0.9, respectively. Neither differences were found regarding mortality (5.2 vs 6/100 patient-years, p = 0.662), ischemic stroke (0.8 vs 1.9/100 patient-years, p = 0.261) and major bleeding rates (3 vs 3.1/100 patient-years, p = 0.983) between morbidly obese population and general population. Nor was there an association found between the degree of obesity and any of the events studied. Conclusion: DOAC are safe and effective in morbidly obese patients.
format	article
author	Begoña Navarro-Almenzar Juan José Cerezo-Manchado Faustino García-Candel
author_facet	Begoña Navarro-Almenzar Juan José Cerezo-Manchado Faustino García-Candel
author_sort	Begoña Navarro-Almenzar
title	Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity
title_short	Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity
title_full	Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity
title_fullStr	Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity
title_full_unstemmed	Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity
title_sort	real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/5274eafe0753478e89c4e78210c8dacd
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Real life behaviour of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and morbid obesity

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