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, Vol. 318, 01.11.2020, p. 67-73.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -