Comparing DOAC and warfarin outcomes in an obese population using the 'real-world' Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)) registry

Document Type

Article

Publication Date

10-1-2024

Publication Title

Vascular medicine (London, England)

Keywords

Humans, Registries, Male, Female, Retrospective Studies, Warfarin, Aged, Hemorrhage, Michigan, Treatment Outcome, Factor Xa Inhibitors, Middle Aged, Obesity, Stroke, Venous Thromboembolism, Atrial Fibrillation, Risk Factors, Administration, Oral, Anticoagulants, Time Factors, Aged, 80 and over, Risk Assessment, Body Mass Index, Recurrence, Quality Improvement

Abstract

INTRODUCTION: Direct oral anticoagulants (DOACs) have overtaken warfarin in the treatment of nonvalvular atrial fibrillation (AF) and venous thromboembolism (VTE). Limited data explore the safety of DOACs in obesity.

METHODS: This multicenter retrospective study between June 2015 and September 2019 uses the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)) registry to compare DOACs and warfarin across weight classes (not obese: body mass index (BMI) ⩾ 18.5 and < 30; obese: BMI ⩾ 30 and < 40; severely obese: BMI ⩾ 40). Primary outcomes include major, clinically relevant nonmajor (CRNM), and minor bleeding events per 100 patient-years. Secondary outcomes include stroke, recurrent VTE, and all-cause mortality.

RESULTS: DOACs were prescribed to 49% of the 4089 patients with AF and 46% of the 3162 patients with VTE. Compared to patients treated with warfarin, those treated with DOACs had a higher estimated glomerular filtration rate across BMI categories regardless of indication. In the AF population, severely obese patients treated with DOACs had more major (3.4 vs 1.8, p = 0.004), CRNM (8.6 vs 5.9, p = 0.019), and minor bleeding (11.4 vs 9.9, p = 0.001). There was no difference in stroke or all-cause mortality. In the VTE population, both CRNM (7.5 vs 6.7, p = 0.042) and minor bleeding (19.3 vs 10.5, p < 0.001) events occurred at higher rates in patients treated with DOACs. There was no difference in recurrent pulmonary embolism, stroke, or all-cause mortality.

CONCLUSION: There is a higher rate of bleeding in severely obese patients with VTE and AF treated with DOACs compared to warfarin, without a difference in secondary outcomes. Further studies to compare the anticoagulant classes and understand bleeding drivers in this population are needed.

Medical Subject Headings

Humans; Registries; Male; Female; Retrospective Studies; Warfarin; Aged; Hemorrhage; Michigan; Treatment Outcome; Factor Xa Inhibitors; Middle Aged; Obesity; Stroke; Venous Thromboembolism; Atrial Fibrillation; Risk Factors; Administration, Oral; Anticoagulants; Time Factors; Aged, 80 and over; Risk Assessment; Body Mass Index; Recurrence; Quality Improvement

PubMed ID

39177515

ePublication

ePub ahead of print

Volume

29

Issue

5

First Page

543

Last Page

552

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