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American Journal of Cardiovascular Drugs

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01-02-2020 | Obesity | Systematic Review

Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation Across BMI Categories: A Systematic Review and Meta-Analysis

Authors: Yue Zhou, Jianyong Ma, Wengen Zhu

Published in: American Journal of Cardiovascular Drugs | Issue 1/2020

Abstract

Objectives

Concerns have arisen recently over the relationship between body mass index (BMI) and outcomes in atrial fibrillation (AF) patients with direct oral anticoagulants (DOACs). This meta-analysis aimed to explore if there is an “obesity paradox” in anticoagulated AF patients, and compare the treatment effects between DOACs and warfarin in AF patients across BMI categories.

Methods

We systematically searched the PubMed and Embase databases until February 26, 2019 for relevant studies. Risk ratios (RRs) with 95% confidence intervals (CIs) were extracted and pooled by a random-effects model.

Results

A total of nine studies were included. Compared with normal weight, underweight was associated with an increased risk of stroke or systemic embolism (SSE) (RR 1.98, 95% CI 1.19–3.28), whereas either overweight or obesity was related with reduced rates of SSE (overweight: RR 0.81, 95% CI 0.71–0.91; obesity: RR 0.69, 95% CI 0.61–0.78) and all-cause death (overweight: RR 0.73, 95% CI 0.64–0.83; obesity: RR 0.72, 95% CI 0.66–0.79). Compared with patients receiving warfarin, patients receiving DOACs who were underweight, normal weight or overweight all had decreased risks of SSE (underweight: RR 0.61, 95% CI 0.46–0.80; normal weight: RR 0.72, 95% CI 0.58–0.91; overweight: RR 0.87, 95% CI 0.76–0.99) and major bleeding (underweight: RR 0.67, 95% CI 0.55–0.81; normal weight: RR 0.72, 95% CI 0.58–0.90; overweight: RR 0.83, 95% CI 0.71–0.96), while obese DOAC users were at no higher risks for SSE and major bleeding.

Conclusions

There may be an obesity paradox in anticoagulated patients with AF. DOACs have better efficacy and safety profiles than warfarin in underweight, normal weight and overweight patients, and are not inferior to warfarin in obese patients.

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Title: Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation Across BMI Categories: A Systematic Review and Meta-Analysis
Authors: Yue Zhou
Jianyong Ma
Wengen Zhu
Publication date: 01-02-2020
Publisher: Springer International Publishing
Keywords: Obesity
Obesity
Edoxaban
Direct Oral Anticoagulant
Underweight
Atrial Fibrillation
Warfarin
Underweight
Direct Oral Anticoagulant
Overweight
Published in: American Journal of Cardiovascular Drugs / Issue 1/2020
Print ISSN: 1175-3277
Electronic ISSN: 1179-187X
DOI: https://doi.org/10.1007/s40256-019-00362-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation Across BMI Categories: A Systematic Review and Meta-Analysis

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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