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Safety and Efficacy of Using Direct Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Patients with Pre-obesity and Obesity

1Leiden University Medical Center, Leiden, Netherlands

Abstract Number: LPB0004

Meeting: ISTH 2021 Congress

Theme: Arterial Thromboembolism » Cerebrovascular Disorders

Background: Evidence of direct oral anticoagulants (DOACs) use in obese atrial fibrillation (AF) patients is limited.

Aims: To investigate the safety and efficacy of DOACs for ischemic stroke prevention among AF patients with different baseline body mass index (BMI).

Methods: Prevalent adult AF patients using DOACs for stroke prevention on 1/1/2017 in the Netherlands were screened and those participated in the Dutch Health Monitor, a survey conducted in participants randomly sampled from the adult Dutch population in (September-December) 2016, were included. BMI from the survey was used to categorize the patients as normal weight (18.5-25kg/m2), pre-obesity (25-30kg/m2), and obesity (≥30kg/m2). Underweight patients (<18.5kg/m2) or those with extreme or missing value of weight (≤25 or ≥275kg), height (≤75 or ≥230cm), or BMI (<14 or ≥50kg/m2) were excluded. The patients were followed from 1/1/2017 to death or 31/12/2018, whichever came first. Major bleeding and ischemic stroke were the study outcomes. Cumulative incidences of the outcomes were estimated by Kaplan-Meier methods, and associations between baseline BMI categories and the outcomes were evaluated by Cox regression models, adjusting for age, sex, HAS-BLED score, CHA2DS2-VASc score, and household income.

Results: A total of 3,033 patients were included (mean age 73.94±7.83 years, 59.3% male), of which 1003 had normal weight (mean BMI 22.93±1.57kg/m2), 1379 had pre-obesity (mean BMI 27.24±1.40kg/m2), and 651 had obesity (mean BMI 33.43±3.28kg/m2). Cumulative incidences of major bleeding within 1 year were 1.20% (95%CI 0.52%-1.87%), 1.53% (95%CI 0.87%-2.17%), and 1.39% (95%CI 0.48%-2.28%) respectively; and were 0.70% (95%CI 0.18%-1.21%), 0.95% (95%CI 0.43%-1.45%), and 0.31% (95%CI 0.00%-0.73%) for ischemic stroke. No statistically significant associations were found between baseline BMI categories and the outcomes.

Kaplan-Meier curves for the studied clinical outcomes according to categories of baseline body mass index (BMI)

Clinical outcomes Crude HR (95% CI) HR (95% CI), adjusting for age, sex HR (95% CI), adjusting for age, sex, HAS-BLED score, CHA2DS2-VASc score, household income
Major bleeding: Pre-obesity (25-30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 1.58 (0.92-2.72) 1.70 (0.98-2.93) 1.64 (0.95-2.83)
Major bleeding: Obesity (≥30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 1.22 (0.62-2.40) 1.43 (0.72-2.83) 1.26 (0.63-2.53)
Major bleeding or major bleeding related death: Pre-obesity (25-30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 1.58 (0.92-2.72) 1.70 (0.99-2.94) 1.65 (0.95-2.85)
Major bleeding or major bleeding related death: Obesity (≥30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 1.30 (0.67-2.53) 1.54 (0.79-3.02) 1.37 (0.69-2.70)
Ischemic stroke: Pre-obesity (25-30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 0.97 (0.53-1.79) 1.06 (0.57-1.95) 1.04 (0.56-1.94)
Ischemic stroke: Obesity (≥30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 0.68 (0.30-1.57) 0.83 (0.36-1.92) 0.64 (0.27-1.50)
Ischemic stroke or ischemic stroke related death: Pre-obesity (25-30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 0.92 (0.50-1.68) 1.00 (0.55-1.83) 0.99 (0.54-1.82)
Ischemic stroke or ischemic stroke related death: Obesity (≥30kg/m2)
(VS normal weight, 18.5-25kg/m2)		 0.65 (0.28-1.47) 0.78 (0.34-1.79) 0.60 (0.26-1.40)

Associations between baseline body mass index (BMI) and prognosis

Conclusions: DOACs appear to provide consistent safety and efficacy in patients with high BMI compared to patients with normal weight, but findings need to be confirmed in a larger cohort.

To cite this abstract in AMA style:

Chen Q, Toorop MM, Cannegieter SC, Lijfering WM. Safety and Efficacy of Using Direct Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Patients with Pre-obesity and Obesity [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/safety-and-efficacy-of-using-direct-oral-anticoagulants-for-stroke-prevention-in-atrial-fibrillation-patients-with-pre-obesity-and-obesity/. Accessed December 11, 2023.

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