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.

3rd Medical Department Cardiology and Intensive Care Medicine Wilhelminen Hospital Vienna Austria; Sigmund Freud University Medical School Vienna Austria

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

Chair of Cardiology University of Pisa Italy

Daiichi Sankyo Europe Munich Germany

Department of Cardiology Medical University of Vienna Austria; Department of Experimental and Clinical Pharmacology Centre for Preclinical Research and Technology Medical University of Warsaw Warsaw Poland

Department of Translational Medicine University of Eastern Piedmont and Maggiore della Carità Hospital Novara Italy

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

Institute of Cardiology Department of Neuroscience Imaging and Clinical Sciences G d'Annunzio University Chieti Pescara Italy

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

Medical Faculty Pilsen of Charles University Czech Republic; Institute of Computer Science of the Czech Academy of Sciences Prague Czech Republic

References provided by Crossref.org

Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry