1 College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD, USA.
2 Department of Pharmacy, Avera McKennan Hospital, Sioux Falls, SD, USA.
Ann Pharmacother. 2019 Feb;53(2):165-170. doi: 10.1177/1060028018796604. Epub 2018 Aug 22.
The International Society of Thrombosis and Haemostasis recommends avoiding direct oral anticoagulants (DOACs) in morbidly obese patients with a body mass index (BMI) >40 kg/m or weight >120 kg because of limited clinical data in this group of patients.
The objective of this study was to evaluate the efficacy and safety of DOACs in morbidly obese patients with atrial fibrillation or flutter.
A retrospective, single-center cohort study was conducted of patients older than 18 years, with BMI >40 kg/m or weight >120 kg, who were diagnosed as having atrial fibrillation or flutter and who received warfarin or DOACs (ie, dabigatran, rivaroxaban, or apixaban). The primary efficacy outcome was the incidence of ischemic stroke or transient ischemic attack (TIA), whereas the primary safety outcome was the incidence of major bleeding.
A total of 64 patients in each group were included in the study analysis. The incidence rate of ischemic stroke or TIA was 1.75%/year in the DOAC group compared with 2.07%/year in the warfarin group (rate ratio = 0.84; 95% CI = 0.23 to 3.14; P = 0.80). The incidence rate of major bleeding was 2.18%/year in the DOAC group, compared with 4.97%/year in the warfarin group (rate ratio = 0.44; 95% CI = 0.15 to 1.25; P = 0.11). Conclusion and Relevance: Apixaban and rivaroxaban may be considered as alternatives to warfarin for atrial fibrillation or flutter in morbidly obese patients. Dabigatran use in morbidly obese patients needs caution until further studies are conducted.
国际血栓与止血学会建议，对于 BMI>40kg/m2 或体重>120kg 的病态肥胖患者，避免使用直接口服抗凝剂（DOAC），因为该组患者的临床数据有限。
本研究旨在评估 DOAC 在病态肥胖合并心房颤动或房扑患者中的疗效和安全性。
对年龄>18 岁、BMI>40kg/m2 或体重>120kg、诊断为心房颤动或房扑且接受华法林或 DOAC（即达比加群、利伐沙班或阿哌沙班）治疗的患者进行回顾性单中心队列研究。主要疗效结局是缺血性卒中和短暂性脑缺血发作（TIA）的发生率，主要安全性结局是大出血的发生率。
每组各有 64 例患者纳入研究分析。DOAC 组缺血性卒中和 TIA 的发生率为 1.75%/年，华法林组为 2.07%/年（发生率比=0.84；95%CI=0.23 至 3.14；P=0.80）。DOAC 组大出血的发生率为 2.18%/年，华法林组为 4.97%/年（发生率比=0.44；95%CI=0.15 至 1.25；P=0.11）。结论和相关性：阿哌沙班和利伐沙班可考虑作为病态肥胖患者治疗心房颤动或房扑的华法林替代药物。达比加群在病态肥胖患者中的应用需要谨慎，直到进一步的研究进行。
