Efficacy and Safety of Direct-Acting Oral Anticoagulants (DOACs) in the Overweight and Obese.
Citation: Advances in Hematology. 2020:3890706, 2020.PMID: 32528538Institution: MedStar Health Research Institute | MedStar Washington Hospital Center | Washington Cancer InstituteDepartment: Hematology and Oncology | Medicine/Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020Abstract: Obesity plays an essential role in the safety of pharmacologic drugs. There is paucity of data for direct oral anticoagulants (DOACs) in the obese, despite these agents becoming more widely used. The primary and secondary objectives of this study were to assess the safety and efficacy of DOACs in the overweight and obese populations when used for primary prophylaxis in the setting of non-valvular atrial fibrillation (NVAF) and for treatment of venous thromboembolisms (VTE). We conducted a retrospective cohort study in a large tertiary care center and obtained data through review of electronic health records. Among patients with NVAF and VTE on apixaban, there were no differences in rates of major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) in the overweight and obese populations when compared to normal weight and underweight individuals. The multivariate adjusted analysis for rivaroxaban found that the odds of CRNMB for patients with BMI <25 was 5.37 (95% CI 1.50-19.32) times higher than that of BMI >=25. Moreover, patients on medications that had known interactions with DOACs had 6.40 times higher odds of CRNMB than patients without such interactions (95% CI 1.49-27.57), which was not accounted for by the effects of aspirin and plavix alone. Efficacy was similar between all weight groups, for both apixaban and rivaroxaban. These results support previous analyses preformed in the large phase III trials and confirm that apixaban and rivaroxaban are safe in the overweight and obese. Copyright (c) 2020 Kimberley Doucette et al.Fiscal year: FY2020Digital Object Identifier: ORCID:- Doucette, Kimberley Fitzpatrick, Kelly Patel, Bhavisha Tefera, Eshetu Vakiti, Anusha:
- https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 Doucette, Kimberley Fitzpatrick, Kelly Patel, Bhavisha Tefera, Eshetu Vakiti, Anusha:
- https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 Doucette, Kimberley Fitzpatrick, Kelly Patel, Bhavisha Tefera, Eshetu Vakiti, Anusha:
- https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 Doucette, Kimberley Fitzpatrick, Kelly Patel, Bhavisha Tefera, Eshetu Vakiti, Anusha:
- https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 Doucette, Kimberley Fitzpatrick, Kelly Patel, Bhavisha Tefera, Eshetu Vakiti, Anusha:
- https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080 https://orcid.org/0000-0003-1165-2250 https://orcid.org/0000-0002-3595-896X https://orcid.org/0000-0002-2974-7701 https://orcid.org/0000-0001-5041-8438 https://orcid.org/0000-0003-1607-7080
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 32528538 | Available | 32528538 |
Obesity plays an essential role in the safety of pharmacologic drugs. There is paucity of data for direct oral anticoagulants (DOACs) in the obese, despite these agents becoming more widely used. The primary and secondary objectives of this study were to assess the safety and efficacy of DOACs in the overweight and obese populations when used for primary prophylaxis in the setting of non-valvular atrial fibrillation (NVAF) and for treatment of venous thromboembolisms (VTE). We conducted a retrospective cohort study in a large tertiary care center and obtained data through review of electronic health records. Among patients with NVAF and VTE on apixaban, there were no differences in rates of major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) in the overweight and obese populations when compared to normal weight and underweight individuals. The multivariate adjusted analysis for rivaroxaban found that the odds of CRNMB for patients with BMI <25 was 5.37 (95% CI 1.50-19.32) times higher than that of BMI >=25. Moreover, patients on medications that had known interactions with DOACs had 6.40 times higher odds of CRNMB than patients without such interactions (95% CI 1.49-27.57), which was not accounted for by the effects of aspirin and plavix alone. Efficacy was similar between all weight groups, for both apixaban and rivaroxaban. These results support previous analyses preformed in the large phase III trials and confirm that apixaban and rivaroxaban are safe in the overweight and obese. Copyright (c) 2020 Kimberley Doucette et al.
English