Albabtain Monirah A, Alanazi Zaid, Al Mutairi Nawaf, Al Hebaishi Yahya, Alyafi Ola, Alghasoon Haneen, Arafat Amr A
Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
J Saudi Heart Assoc. 2023 Feb 27;35(1):7-15. doi: 10.37616/2212-5043.1327. eCollection 2023.
The efficacy and safety of non-vitamin K-dependent anticoagulants (NOAC) are not well investigated in the obese population, and fixed dosing could lead to under-anticoagulation. Our objective was to evaluate the effect of obesity on anticoagulation outcomes and survival in non-valvular atrial fibrillation (AF) patients.
We enrolled 755 patients who required anticoagulation for AF from 2015 to 2016. We grouped the patients into four groups. Group 1 (n = 297) included patients with BMI< 40 kg/m2 treated with NOACs, Group 2 (n = 358) included patients on warfarin with BMI< 40 kg/m2, Group 3 (n = 57) had patients on NOACs with BMI≥ 40 kg/m2 and Group 4 (n = 43) included patients on warfarin and BMI≥ 40 kg/m2. Study outcomes were the composite endpoint of stroke, bleeding, and survival.
Competing risk regression showed that stroke and bleeding were not affected by obesity or treatment (SHR: 1.09 (95% CI: 0.79-1.51); P = 0.62). Older age was the predictor of stroke/bleeding (HR:1.03 (95% CI:1.01-1.06); P = 0.02). Predictors of mortality were heart failure (HR:2.23 (95% CI:1.25-3.97); P = 0.007), lower creatinine clearance (HR: 0.98 (95% CI:0.97-0.98): P < 0.001), non-obese patients on warfarin (HR:3.51 (95%CI:1.6-7.7): P = 0.002) and obese patients on warfarin (HR: 6.7 (95% CI:2.51-17.92); P < 0.001).
NOACs could have a similar risk profile to warfarin in obese and non-obese patients with non-valvular AF but could have better survival. Larger randomized trials are recommended.
非维生素K依赖型抗凝剂（NOAC）在肥胖人群中的疗效和安全性尚未得到充分研究，固定剂量可能导致抗凝不足。我们的目的是评估肥胖对非瓣膜性心房颤动（AF）患者抗凝结局和生存的影响。
我们纳入了2015年至2016年期间需要接受AF抗凝治疗的755例患者。我们将患者分为四组。第1组（n = 297）包括体重指数（BMI）<40kg/m²且接受NOAC治疗的患者，第2组（n = 358）包括BMI<40kg/m²且接受华法林治疗的患者，第3组（n = 57）包括BMI≥40kg/m²且接受NOAC治疗的患者，第4组（n = 43）包括BMI≥40kg/m²且接受华法林治疗的患者。研究结局为卒中、出血和生存的复合终点。
竞争风险回归显示，肥胖或治疗对卒中和出血无影响（标准化风险比：1.09（95%置信区间：0.79 - 1.51）；P = 0.62）。年龄较大是卒中和出血的预测因素（风险比：1.03（95%置信区间：1.01 - 1.06）；P = 0.02）。死亡的预测因素为心力衰竭（风险比：2.23（95%置信区间：1.25 - 3.97）；P = 0.007）、较低的肌酐清除率（风险比：0.98（95%置信区间：0.97 - 0.98）：P < 0.001）、接受华法林治疗的非肥胖患者（风险比：3.51（95%置信区间：1.6 - 7.7）：P = 0.002）和接受华法林治疗的肥胖患者（风险比：6.7（95%置信区间：2.51 - 17.92）；P < 0.001）。
在肥胖和非肥胖的非瓣膜性AF患者中，NOAC的风险特征可能与华法林相似，但生存情况可能更好。建议进行更大规模的随机试验。
