Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review
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The International Society on Thrombosis and Haemostasis recommends avoiding the use of direct oral anticoagulants (DOACs) in patients with a body mass index (BMI) greater than 40 kg/m2 or weight greater than 120 kg.
Higher BMI is associated with altered pharmacokinetics which may affect the safety and effectiveness for DOACs.
Data were collected on 3458 patients taking a DOAC prior to admission to a Midwestern health system between February 2013 and August 2016. Of these, 43 patients had a thrombotic event and 70 patients had an overt bleeding event. Patients were stratified among the following three BMI groups: BMI < 30 kg/m2, BMI 30–40 kg/m2, and BMI > 40 kg/m2.
There was no statistically significant difference between BMI groups for thrombotic events (p = 0.598) or for overt bleeding events (p = 0.065). The BMI < 30 kg/m2 had the highest occurrence rate of bleeding events. It was observed that bleeding occurrence decreased as the BMI groups increased. The BMI > 40 kg/m2 group had the lowest risk of bleeding events, and was the only group to have a higher occurrence rate of thrombotic events compared to bleeding events.
Among patients admitted to a single health system on DOAC therapy over a three-and-a-half-year period, obesity did not significantly correlate with thrombotic or overt bleeding complications. This study is limited as a single health system study with low overall event rates. A preliminary finding of this study showed a trend towards decreased bleeding frequency as BMI increased.
KeywordsDirect oral anticoagulants Pharmacology Body mass index Obesity
Sarah Meeks for mentorship & Sarah Ferrell and Christopher Liston for aiding in data collection.
Dr. William Wilson is a member on the Eliquis® Advisory Board but accepts no financial contributions. No financial support or grants were used to fund this study. All funding was done by Parkview Health.
- 2.January CT, Wann LS, Alpert JS et al (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 130(23):2071–2104CrossRefGoogle Scholar
- 8.Dobesh PP, Fanikos J (2016) Reducing the risk of stroke in patients with nonvalvular atrial fibrillation with direct oral anticoagulants. Is one of these not like the others? J Atr Fibrillation 9(2):1481Google Scholar
- 12.Kaatz S, Ahmad D, Spyropoulos AC, Schulman S (2015) Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH. J Thromb Haemost 13:2119–2126CrossRefGoogle Scholar
- 16.Body mass index – BMI. Euro.who.int. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Accessed September 23, 2018.
- 17.Graves KK, Edholm K, Johnson SA (2017) Use of oral anticoagulants in obese patients. JSM Atheroscler. 2(4):1035Google Scholar
- 25.Balla SR, Cyr DD, Lokhnygina Y et al (2017) Relation of risk of stroke in patients with atrial fibrillation to body mass index (from patients treated with rivaroxaban and warfarin in the rivaroxaban once daily oral direct factor xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation trial). Am J Cardiol 119(12):1989–1996CrossRefGoogle Scholar