Caverley Zachary R, Bindler Ross J, Soh Pamela, Mendelson Sherri
Providence Oregon Cardiology Group, Astoria, OR, USA.
Washington State University Spokane, College of Nursing and Elson S. Floyd College of Medicine, Spokane, WA, USA.
Am J Med Sci. 2023 May;365(5):413-419. doi: 10.1016/j.amjms.2023.01.004. Epub 2023 Jan 22.
Direct oral anticoagulants (DOACs) are often used in patients with atrial fibrillation or flutter instead of warfarin and although supporting evidence is limited, available studies suggest this may be an acceptable route of care. Our study assessed the question: are DOACs as effective and safe as warfarin in patients with atrial fibrillation and class III obesity specifically in a rural population?
A retrospective analysis was conducted by examining the first 6-12 months of therapy with a DOAC (apixaban or rivaroxaban) or warfarin in patients with weight >120kg or class III obesity. Events of interest, thrombosis and bleeding, were documented for analysis. The risk and odds of events of interest for both groups were calculated and compared.
Characteristics of both arms were similar (DOAC n=42; warfarin n=43). A lack of thrombosis events limited efficacy analysis. A total of 22 bleeds occurred with 8 in patients prescribed a DOAC (7 minor; 1 major) and 14 in those prescribed warfarin (12 minor; 2 major). Weight in kg (p<0.001), BMI (p=0.013) and HAS-BLED score (p=0.035) were predictive of a first bleeding event in patients prescribed warfarin. The odds ratio for any type of bleed on DOAC vs warfarin was 0.55 (0.180-1.681; 95% CI).
In patients with atrial fibrillation and class III obesity, regarding safety, DOACs appear to be non-inferior to warfarin during the first six to 12 months of therapy in our rural population - consistent with other analyses; however, the lack of thrombosis events limited the efficacy analysis.
直接口服抗凝剂（DOACs）常用于心房颤动或心房扑动患者，以替代华法林。尽管支持证据有限，但现有研究表明这可能是一种可接受的治疗途径。我们的研究评估了以下问题：在患有心房颤动且为III级肥胖的患者中，尤其是在农村人群中，DOACs与华法林相比是否同样有效且安全？
通过检查体重>120kg或III级肥胖患者使用DOAC（阿哌沙班或利伐沙班）或华法林治疗的前6至12个月进行回顾性分析。记录感兴趣的事件，即血栓形成和出血，以进行分析。计算并比较两组感兴趣事件的风险和几率。
两组的特征相似（DOAC组n = 42；华法林组n = 43）。缺乏血栓形成事件限制了疗效分析。共发生22次出血事件，服用DOAC的患者中有8次（7次轻微；1次严重），服用华法林的患者中有14次（12次轻微；2次严重）。以千克为单位的体重（p<0.001）、体重指数（BMI）（p = 0.013）和HAS - BLED评分（p = 0.035）可预测服用华法林患者的首次出血事件。DOAC与华法林相比，任何类型出血的优势比为0.55（0.180 - 1.681；95%置信区间）。
在患有心房颤动且为III级肥胖的患者中，就安全性而言，在我们的农村人群中，DOACs在治疗的前6至12个月似乎不劣于华法林——这与其他分析结果一致；然而，缺乏血栓形成事件限制了疗效分析。
