Meta-Analysis Comparing Direct Oral Anticoagulants Versus Warfarin in Morbidly Obese Patients With Atrial Fibrillation
Section snippets
Methods
MEDLINE, Embase, Google Scholar, Web of Science, and Cochrane Library database searches for relevant articles through 12/23/19 were performed. The keywords used were (dabigatran OR rivaroxaban OR apixaban OR edoxaban OR warfarin) AND (obese OR obesity).
Two reviewers (KK, MH) independently performed the study selection based on the pre-specified inclusion and exclusion criteria. Studies were included if included patients are aged > 18 years old with BMI > 40 kg/m2 or weight > 120 kg receiving
Results
A total of 321 studies was screened and 16 studies were assessed for eligibility. Of those studies reviewed, 5 studies were included for our meta-analysis (Figure 1).9, 10, 11, 12, 13
The study by Aloi et al14 was excluded because patients receiving warfarin were not included as a control group. The post hoc study of the ARISTOLE trial by Sandhu et al15 was excluded because another post hoc study by Hohnloser et al included the same cohort. The study by Kalani et al16 was also excluded because
Discussion
Our meta-analysis showed there was no significant difference in the event rate of stroke or SE between the DOAC and warfarin cohorts with AF, but the DOAC use was significantly associated with lower major bleeding event rate compared with the warfarin group.
The pivotal phase 3 clinical trials compared a DOAC with warfarin in general population with nonvalvular AF, and they showed that the DOAC therapy showed noninferiority or superiority to the warfarin therapy in the prevention of stroke or SE.
Authors’ Contribution
Kazuhiko Kido: conceptualization, investigation, methodology, writing-original draft and writing-review and editing; Mikiko Shimizu: methodology, software, writing-review and editing; Tsuyoshi Shiga: Conceptualization, resources, writing-review and editing; Masayuki Hashiguchi: supervision, software, investigation, writing-review and editing.
Disclosures
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Tsuyoshi Shiga is a member of the speaker bureau for Bristol-Myers Squibb.
Acknowledgement
Authors would like to thank Dr. Renato Lopes MD, Ph.D for providing us with additional information on the included study by Hohnloser et al for data analysis. Without your help, we could not have completed this meta-analysis.
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Cited by (27)
Safety and efficacy of direct oral anticoagulants in comparison with warfarin across different BMI ranges: A systematic review and meta-analysis
2022, Annals of Medicine and SurgeryCitation Excerpt :More investigation should be done debating whether warfarin or NVKAs are the better choice for high risk VTE patients. According to the linked studies, DOACs remain to be the preferable choice regardless, due to their rapid onset of action, standard dosages without the need of titration, lack of requirement of routine check-ups, and limited interactions with food and associated drugs [34-57]. Many limitations were acknowledged in our study, consequently further studies should take into account these restrictions when collecting data.
Oral Anticoagulant Use in Morbid Obesity and Post Bariatric Surgery: A Review
2021, American Journal of MedicineCitation Excerpt :Hence, the results may not be generalizable to other patient populations. Similarly, another meta-analysis included 5 studies that evaluated use of DOAC and warfarin in morbidly obese patients with atrial fibrillation.20 It showed that there were no differences in stroke or thromboembolism in both groups (OR 0.85; 95% confidence interval, 0.60-1.19; P = 0.35; I2 = 0%).
Peak plasma rivaroxaban levels in patients weighing 120 kg or greater
2021, Thrombosis ResearchNetwork Meta-Analysis Comparing Apixaban Versus Rivaroxaban in Morbidly Obese Patients With Atrial Fibrillation
2020, American Journal of CardiologyFactor Xa Inhibitors versus warfarin in patients with morbid obesity and atrial fibrillation
2024, European Journal of Clinical PharmacologyTherapeutic Drug Monitoring of Direct Oral Anticoagulants in Patients with Extremely Low and High Body Weight—Pilot Study
2023, Journal of Clinical Medicine
Funding: Dr. Kido received the American College of Clinical Pharmacy Cardiology Practice Research Network Seed Grant, 009389-00001 for this meta-analysis research, Lenexa.