Clinical outcomes of dabigatran use in patients with non-valvular atrial fibrillation and weight >120 kg.
Clinical outcomes of dabigatran use in patients with non-valvular atrial fibrillation and weight >120 kg.
- 2021
BACKGROUND: Patients with obesity were underrepresented in studies evaluating the safety and effectiveness of direct oral anticoagulants (DOAC) in patients with non-valvular atrial fibrillation (NVAF). This study compared clinical outcomes in patients with NVAF and weighing >120 kg and <=120 kg who were receiving dabigatran. CONCLUSIONS: In patients with NVAF and >120 kg, dabigatran use was associated with a small increased risk of gastrointestinal bleeding but no differences in stroke, mortality or clinically-relevant bleeding. These findings suggest that dabigatran use is reasonable in patients with NVAF and weight >120 kg. Copyright © 2021 Elsevier Ltd. All rights reserved. MATERIALS AND METHODS: This retrospective, matched, longitudinal cohort study included patients from three integrated healthcare delivery systems. Patients >=18 years of age with NVAF were included if between September 1, 2016 and June 30, 2019 they received dabigatran. Patients >120 kg and <=120 kg were matched up to 1:6 on age, sex, and CHA2DS2-VASc score. Data were extracted from administrative databases. The primary outcome was a composite of ischemic stroke, clinically-relevant bleeding, systemic embolism, and all-cause mortality. Multivariable regression analyses were performed. RESULTS: 777 and 3522 patients >120 kg and <=120 kg, respectively, were matched. The >120 kg group tended to be younger with a higher burden of chronic disease. There was no difference between groups in the composite outcome (adjusted hazard ratio [AHR] 1.10, 95% confidence interval 0.89-1.37) or individual components of the composite. A subanalysis of clinically-relevant bleeding identified that patients >120 kg were at a greater risk of gastrointestinal bleeding (AHR 1.44, 95% CI 1.01-2.05).
English
0049-3848
10.1016/j.thromres.2021.11.007 [doi] S0049-3848(21)00517-X [pii]
*Atrial Fibrillation
*Dabigatran
Atrial Fibrillation/co [Complications]
Atrial Fibrillation/dt [Drug Therapy]
Dabigatran/ae [Adverse Effects]
Gastrointestinal Hemorrhage
Humans
Longitudinal Studies
Retrospective Studies
Washington Cancer Institute
Journal Article
BACKGROUND: Patients with obesity were underrepresented in studies evaluating the safety and effectiveness of direct oral anticoagulants (DOAC) in patients with non-valvular atrial fibrillation (NVAF). This study compared clinical outcomes in patients with NVAF and weighing >120 kg and <=120 kg who were receiving dabigatran. CONCLUSIONS: In patients with NVAF and >120 kg, dabigatran use was associated with a small increased risk of gastrointestinal bleeding but no differences in stroke, mortality or clinically-relevant bleeding. These findings suggest that dabigatran use is reasonable in patients with NVAF and weight >120 kg. Copyright © 2021 Elsevier Ltd. All rights reserved. MATERIALS AND METHODS: This retrospective, matched, longitudinal cohort study included patients from three integrated healthcare delivery systems. Patients >=18 years of age with NVAF were included if between September 1, 2016 and June 30, 2019 they received dabigatran. Patients >120 kg and <=120 kg were matched up to 1:6 on age, sex, and CHA2DS2-VASc score. Data were extracted from administrative databases. The primary outcome was a composite of ischemic stroke, clinically-relevant bleeding, systemic embolism, and all-cause mortality. Multivariable regression analyses were performed. RESULTS: 777 and 3522 patients >120 kg and <=120 kg, respectively, were matched. The >120 kg group tended to be younger with a higher burden of chronic disease. There was no difference between groups in the composite outcome (adjusted hazard ratio [AHR] 1.10, 95% confidence interval 0.89-1.37) or individual components of the composite. A subanalysis of clinically-relevant bleeding identified that patients >120 kg were at a greater risk of gastrointestinal bleeding (AHR 1.44, 95% CI 1.01-2.05).
English
0049-3848
10.1016/j.thromres.2021.11.007 [doi] S0049-3848(21)00517-X [pii]
*Atrial Fibrillation
*Dabigatran
Atrial Fibrillation/co [Complications]
Atrial Fibrillation/dt [Drug Therapy]
Dabigatran/ae [Adverse Effects]
Gastrointestinal Hemorrhage
Humans
Longitudinal Studies
Retrospective Studies
Washington Cancer Institute
Journal Article