O'Kane Cavan P, Avalon Juan Carlo O, Lacoste Jordan L, Fang Wei, Bianco Christopher M, Davisson Laura, Piechowski Kara L
Department of Pharmacy, WVU Medicine, Morgantown, West Virginia, USA.
Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Pharmacotherapy. 2022 Feb;42(2):112-118. doi: 10.1002/phar.2651. Epub 2021 Dec 9.
Apixaban and rivaroxaban are increasingly used for thromboembolism prophylaxis in patients with non-valvular atrial fibrillation (NVAF) and commonly in patients with obesity and body mass index (BMI) ≥50 kg/m despite the limited data.
This study aimed to establish the effectiveness and safety of apixaban and rivaroxaban in patients with NVAF and BMI ≥50 kg/m .
A single health-system, retrospective cohort study evaluated the effectiveness and safety of apixaban and rivaroxaban initiated in adult patients (≥18 years of age) with BMI ≥50 kg/m and NVAF. Outcomes of ischemic stroke, systemic embolic events, and bleeding were compared to a cohort of patients with BMI 18 to 30 kg/m .
After 1619 patient-years worth of follow-up in 595 patients, the primary endpoint of incidence of ischemic stroke was numerically similar in both groups, 1.3 per 100 patient-years in the BMI ≥50 kg/m group, compared to 2.0 per 100 patient-years in the BMI <30 kg/m group (RR 0.65, 95% CI 0.38-1.82, p = 0.544). Incidence of major bleeding and clinically relevant non-major bleeding was also numerically similar between the two groups.
This study demonstrated that apixaban and rivaroxaban in patients with a BMI ≥50 kg/m for treatment of NVAF may be safe and effective at preventing thromboembolic events and had no increased risk of bleeding. Although, findings should be interpreted with caution and confirmed with additional studies. This study contributes to the growing body of evidence that direct oral anticoagulants (DOACs) may be effective and safe to use for the treatment of NVAF in patients with BMI ≥50 kg/m .
阿哌沙班和利伐沙班越来越多地用于非瓣膜性心房颤动（NVAF）患者的血栓栓塞预防，尽管数据有限，但肥胖且体重指数（BMI）≥50kg/m²的患者也常用。
本研究旨在确定阿哌沙班和利伐沙班在BMI≥50kg/m²的NVAF患者中的有效性和安全性。
一项单医疗系统的回顾性队列研究评估了阿哌沙班和利伐沙班在BMI≥50kg/m²且患有NVAF的成年患者（≥18岁）中的有效性和安全性。将缺血性卒中、全身性栓塞事件和出血的结果与BMI为18至30kg/m²的患者队列进行比较。
在595例患者进行了相当于1619患者年的随访后，两组缺血性卒中发生率的主要终点在数值上相似，BMI≥50kg/m²组为每100患者年1.3例，而BMI<30kg/m²组为每100患者年2.0例（RR 0.65，95%CI 0.38 - 1.82，p = 0.544）。两组之间大出血和临床相关非大出血的发生率在数值上也相似。
本研究表明，阿哌沙班和利伐沙班用于治疗BMI≥50kg/m²的NVAF患者在预防血栓栓塞事件方面可能是安全有效的，且出血风险没有增加。尽管如此，研究结果应谨慎解释，并通过更多研究加以证实。本研究为越来越多的证据做出了贡献，即直接口服抗凝剂（DOACs）用于治疗BMI≥50kg/m²的NVAF患者可能是安全有效的。
