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Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies

G. Patti, L. Pecen, MC. Manu, K. Huber, M. Rohla, G. Renda, J. Siller-Matula, F. Ricci, P. Kirchhof, R. Caterina

. 2020 ; 318 (-) : 67-73. [pub] 20200621

Jazyk angličtina Země Nizozemsko

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc21019895

BACKGROUND: Data on the relationship between body mass index (BMI), thromboembolic events (TEE) and bleeding in patients with atrial fibrillation (AF) are controversial, and further evidence on the risk of such events in obese patients with AF receiving different anticoagulant therapies (OAC) is needed. METHODS AND RESULTS: We divided a total of 9330 participants from the prospective PREFER in AF and PREFER in AF PROLONGATION registries into BMI quartiles at baseline. Outcome measures were TEE and major bleeding complications at the 1-year follow-up. Without OAC, there was a ≥6-fold increase of TEE in the 4th vs other BMI quartiles (P = .019). OAC equalized the rates of TEE across different BMI strata. The occurrence of major bleeding was highest in patients with BMI in the 1st as well as in the 4th BMI quartile [OR 1.69, 95% CI 1.03-2.78, P = .039 and OR 1.86, 95% CI 1.13-3.04, P = .014 vs those in the 3rd quartile, respectively]. At propensity score-adjusted analysis, the incidence of TEE and major bleeding in obese patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K-antagonist anticoagulants (VKAs) was similar (P ≥ .34). CONCLUSIONS: Our real-world data suggest no obesity paradox for TEE in patients with AF. Obese patients are at higher risk of TEE, and here OAC dramatically reduces the risk of events. We here found a comparable clinical outcome with NOACs and VKAs in obese patients. Low body weight and obesity were also associated with bleeding, and therefore OAC with the best safety profile should be considered in this setting.

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$a Patti, Giuseppe $u Department of Translational Medicine, University of Eastern Piedmont and Maggiore della Carità Hospital, Novara, Italy. Electronic address: giuseppe.patti@uniupo.it
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$a BACKGROUND: Data on the relationship between body mass index (BMI), thromboembolic events (TEE) and bleeding in patients with atrial fibrillation (AF) are controversial, and further evidence on the risk of such events in obese patients with AF receiving different anticoagulant therapies (OAC) is needed. METHODS AND RESULTS: We divided a total of 9330 participants from the prospective PREFER in AF and PREFER in AF PROLONGATION registries into BMI quartiles at baseline. Outcome measures were TEE and major bleeding complications at the 1-year follow-up. Without OAC, there was a ≥6-fold increase of TEE in the 4th vs other BMI quartiles (P = .019). OAC equalized the rates of TEE across different BMI strata. The occurrence of major bleeding was highest in patients with BMI in the 1st as well as in the 4th BMI quartile [OR 1.69, 95% CI 1.03-2.78, P = .039 and OR 1.86, 95% CI 1.13-3.04, P = .014 vs those in the 3rd quartile, respectively]. At propensity score-adjusted analysis, the incidence of TEE and major bleeding in obese patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K-antagonist anticoagulants (VKAs) was similar (P ≥ .34). CONCLUSIONS: Our real-world data suggest no obesity paradox for TEE in patients with AF. Obese patients are at higher risk of TEE, and here OAC dramatically reduces the risk of events. We here found a comparable clinical outcome with NOACs and VKAs in obese patients. Low body weight and obesity were also associated with bleeding, and therefore OAC with the best safety profile should be considered in this setting.
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$a Pecen, Ladislav $u Medical Faculty Pilsen of Charles University, Czech Republic; Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
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$a Manu, Marius Constantin $u Daiichi Sankyo Europe, Munich, Germany
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$a Huber, Kurt $u 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
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$a Rohla, Miklos $u 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria; Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
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$a Renda, Giulia $u Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti-Pescara, Italy
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$a Siller-Matula, Jolanta $u Department of Cardiology, Medical University of Vienna, Austria; Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
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$a Ricci, Fabrizio $u Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Department of Clinical Sciences, Lund University, Malmö, Sweden
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$a Kirchhof, Paulus $u Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trust, Birmingham, UK; Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
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$a Caterina, Raffaele De $u Chair of Cardiology, University of Pisa, Italy. Electronic address: raffaele.decaterina@unipi.it
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