Background: Direct-acting oral anticoagulants (DOACs) are licensed for stroke prevention in non-valvular atrial fibrillation and prevention and treatment of venous thromboembolism (VTE). There is uncertainty about the efficacy and safety of the licensed doses for these indications in the obese population, particularly those with a weight greater than 120kgs¹.
Our previous audit conducted in 2017, which looked at whether high body weight reduced drug exposure to apixaban and rivaroxaban using anti-Xa levels, found no evidence of reduced drug exposure in this patient group.

Aims: To identify whether high body weight affects clinical outcomes for patients on apixaban and rivaroxaban.

Methods: The patient cohort from the 2017 audit were followed up in January 2020. Each patient was contacted via telephone to ask if they had experienced: VTE recurrence, CVA (cerebrovascular accident), a major bleeding event or a non-major bleeding event.

Results: Of the 30 patients contacted to ask about clinical outcomes, 2 patients were uncontactable and therefore excluded and 5 patients had died. For 4 of the 5 patients who died, the cause of death was not a result of VTE, CVA or a bleed. The cause of death for the remaining patient remains unknown. For the remaining 23 patients, there were no VTE recurrence events, CVA events or major bleeding. There were 2 episodes of non-major bleeding reported, both of these being nosebleeds. The follow up period was 2 years.

[Baseline characteristics and findings]

[Clinical outcomes]

Conclusions: In this prospective cohort study, we found few adverse clinical outcomes for high body weight patients receiving DOACs over a 2 year follow-up period. However, this study is limited by the lack of a comparative group of “normal” weights. More studies in this important area are required.

« Back to ISTH 2020 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/clinical-outcomes-for-patients-of-high-body-weight-on-apixaban-or-rivaroxaban/