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Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies

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Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies. / Patti, Giuseppe; Pecen, Ladislav; Manu, Marius Constantin; Huber, Kurt; Rohla, Miklos; Renda, Giulia; Siller-Matula, Jolanta; Ricci, Fabrizio; Kirchhof, Paulus; Caterina, Raffaele De.

in: INT J CARDIOL, Jahrgang 318, 01.11.2020, S. 67-73.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Patti, G, Pecen, L, Manu, MC, Huber, K, Rohla, M, Renda, G, Siller-Matula, J, Ricci, F, Kirchhof, P & Caterina, RD 2020, 'Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies', INT J CARDIOL, Jg. 318, S. 67-73. https://doi.org/10.1016/j.ijcard.2020.06.010

APA

Patti, G., Pecen, L., Manu, M. C., Huber, K., Rohla, M., Renda, G., Siller-Matula, J., Ricci, F., Kirchhof, P., & Caterina, R. D. (2020). Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies. INT J CARDIOL, 318, 67-73. https://doi.org/10.1016/j.ijcard.2020.06.010

Vancouver

Patti G, Pecen L, Manu MC, Huber K, Rohla M, Renda G et al. Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies. INT J CARDIOL. 2020 Nov 1;318:67-73. https://doi.org/10.1016/j.ijcard.2020.06.010

Bibtex

@article{85e8706c2ef748658cf2b2a95adf940c,
title = "Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies",
abstract = "BACKGROUND: Data on the relationship between body mass index (BMI), thromboembolic events (TEE) and bleeding in patients with atrial fibrillation (AF) are controversial, and further evidence on the risk of such events in obese patients with AF receiving different anticoagulant therapies (OAC) is needed.METHODS AND RESULTS: We divided a total of 9330 participants from the prospective PREFER in AF and PREFER in AF PROLONGATION registries into BMI quartiles at baseline. Outcome measures were TEE and major bleeding complications at the 1-year follow-up. Without OAC, there was a ≥6-fold increase of TEE in the 4th vs other BMI quartiles (P = .019). OAC equalized the rates of TEE across different BMI strata. The occurrence of major bleeding was highest in patients with BMI in the 1st as well as in the 4th BMI quartile [OR 1.69, 95% CI 1.03-2.78, P = .039 and OR 1.86, 95% CI 1.13-3.04, P = .014 vs those in the 3rd quartile, respectively]. At propensity score-adjusted analysis, the incidence of TEE and major bleeding in obese patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K-antagonist anticoagulants (VKAs) was similar (P ≥ .34).CONCLUSIONS: Our real-world data suggest no obesity paradox for TEE in patients with AF. Obese patients are at higher risk of TEE, and here OAC dramatically reduces the risk of events. We here found a comparable clinical outcome with NOACs and VKAs in obese patients. Low body weight and obesity were also associated with bleeding, and therefore OAC with the best safety profile should be considered in this setting.",
keywords = "Administration, Oral, Anticoagulants/adverse effects, Atrial Fibrillation/diagnosis, Humans, Obesity/complications, Prospective Studies, Risk Factors, Stroke/drug therapy, Treatment Outcome",
author = "Giuseppe Patti and Ladislav Pecen and Manu, {Marius Constantin} and Kurt Huber and Miklos Rohla and Giulia Renda and Jolanta Siller-Matula and Fabrizio Ricci and Paulus Kirchhof and Caterina, {Raffaele De}",
note = "Copyright {\textcopyright} 2020 Elsevier B.V. All rights reserved.",
year = "2020",
month = nov,
day = "1",
doi = "10.1016/j.ijcard.2020.06.010",
language = "English",
volume = "318",
pages = "67--73",
journal = "INT J CARDIOL",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

RIS

TY - JOUR

T1 - Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies

AU - Patti, Giuseppe

AU - Pecen, Ladislav

AU - Manu, Marius Constantin

AU - Huber, Kurt

AU - Rohla, Miklos

AU - Renda, Giulia

AU - Siller-Matula, Jolanta

AU - Ricci, Fabrizio

AU - Kirchhof, Paulus

AU - Caterina, Raffaele De

N1 - Copyright © 2020 Elsevier B.V. All rights reserved.

PY - 2020/11/1

Y1 - 2020/11/1

N2 - BACKGROUND: Data on the relationship between body mass index (BMI), thromboembolic events (TEE) and bleeding in patients with atrial fibrillation (AF) are controversial, and further evidence on the risk of such events in obese patients with AF receiving different anticoagulant therapies (OAC) is needed.METHODS AND RESULTS: We divided a total of 9330 participants from the prospective PREFER in AF and PREFER in AF PROLONGATION registries into BMI quartiles at baseline. Outcome measures were TEE and major bleeding complications at the 1-year follow-up. Without OAC, there was a ≥6-fold increase of TEE in the 4th vs other BMI quartiles (P = .019). OAC equalized the rates of TEE across different BMI strata. The occurrence of major bleeding was highest in patients with BMI in the 1st as well as in the 4th BMI quartile [OR 1.69, 95% CI 1.03-2.78, P = .039 and OR 1.86, 95% CI 1.13-3.04, P = .014 vs those in the 3rd quartile, respectively]. At propensity score-adjusted analysis, the incidence of TEE and major bleeding in obese patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K-antagonist anticoagulants (VKAs) was similar (P ≥ .34).CONCLUSIONS: Our real-world data suggest no obesity paradox for TEE in patients with AF. Obese patients are at higher risk of TEE, and here OAC dramatically reduces the risk of events. We here found a comparable clinical outcome with NOACs and VKAs in obese patients. Low body weight and obesity were also associated with bleeding, and therefore OAC with the best safety profile should be considered in this setting.

AB - BACKGROUND: Data on the relationship between body mass index (BMI), thromboembolic events (TEE) and bleeding in patients with atrial fibrillation (AF) are controversial, and further evidence on the risk of such events in obese patients with AF receiving different anticoagulant therapies (OAC) is needed.METHODS AND RESULTS: We divided a total of 9330 participants from the prospective PREFER in AF and PREFER in AF PROLONGATION registries into BMI quartiles at baseline. Outcome measures were TEE and major bleeding complications at the 1-year follow-up. Without OAC, there was a ≥6-fold increase of TEE in the 4th vs other BMI quartiles (P = .019). OAC equalized the rates of TEE across different BMI strata. The occurrence of major bleeding was highest in patients with BMI in the 1st as well as in the 4th BMI quartile [OR 1.69, 95% CI 1.03-2.78, P = .039 and OR 1.86, 95% CI 1.13-3.04, P = .014 vs those in the 3rd quartile, respectively]. At propensity score-adjusted analysis, the incidence of TEE and major bleeding in obese patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K-antagonist anticoagulants (VKAs) was similar (P ≥ .34).CONCLUSIONS: Our real-world data suggest no obesity paradox for TEE in patients with AF. Obese patients are at higher risk of TEE, and here OAC dramatically reduces the risk of events. We here found a comparable clinical outcome with NOACs and VKAs in obese patients. Low body weight and obesity were also associated with bleeding, and therefore OAC with the best safety profile should be considered in this setting.

KW - Administration, Oral

KW - Anticoagulants/adverse effects

KW - Atrial Fibrillation/diagnosis

KW - Humans

KW - Obesity/complications

KW - Prospective Studies

KW - Risk Factors

KW - Stroke/drug therapy

KW - Treatment Outcome

U2 - 10.1016/j.ijcard.2020.06.010

DO - 10.1016/j.ijcard.2020.06.010

M3 - SCORING: Journal article

C2 - 32574823

VL - 318

SP - 67

EP - 73

JO - INT J CARDIOL

JF - INT J CARDIOL

SN - 0167-5273

ER -