Salah Qais M, Bhandari Sagar, Chand Ali, Khan Saif, Tirmzi Syed Haider Ali, Sheikh Majed, Khreis Khaldoun, Palleti Sujith K
Internal Medicine, Al-Quds University Faculty of Medicine, Jerusalem, PSE.
Cardiology, Tucson Medical Center, Tucson, USA.
Cureus. 2023 Jul 10;15(7):e41619. doi: 10.7759/cureus.41619. eCollection 2023 Jul.
Atrial fibrillation (AF) is a cardiac condition characterized by an irregular heart rhythm, which is increasingly prevalent in the modern era. All international guidelines strongly advise the administration of anticoagulants to individuals with AF who are at high risk of stroke. These guidelines recommend the use of direct oral anticoagulants (DOACs) over warfarin because warfarin is significantly associated with increased rates of major bleeding, numerous interactions with food and drugs, and the necessity for frequent monitoring. The aim of this study is to compare the effectiveness and safety of direct oral anticoagulants (DOACs) in obese patients with atrial fibrillation. Two authors independently conducted a comprehensive literature search using electronic databases including PubMed, CINAHL, and EMBASE from inception to June 1, 2023. The efficacy outcome assessed in this meta-analysis included the composite of stroke and systemic embolism. For safety analysis, major bleeding events were compared among the study groups. Eleven studies fulfilled all the inclusion criteria and were included in the present meta-analysis enrolling 144,502 patients. In this study, DOACs demonstrate superior efficacy in preventing stroke/systemic embolism compared to warfarin. Among the DOACs, apixaban emerged as the most effective, followed by rivaroxaban, warfarin, and dabigatran. In terms of safety, apixaban was also found to be the most favorable treatment option, followed by rivaroxaban, dabigatran, and warfarin. In summary, our study concludes that apixaban exhibited greater effectiveness and safety when compared to other DOACs and warfarin in obese patients with AF.
心房颤动（AF）是一种以心律不齐为特征的心脏疾病，在现代社会中日益普遍。所有国际指南都强烈建议对有中风高风险的房颤患者使用抗凝剂。这些指南推荐使用直接口服抗凝剂（DOACs）而非华法林，因为华法林与大出血发生率增加、与食物和药物的众多相互作用以及频繁监测的必要性显著相关。本研究的目的是比较直接口服抗凝剂（DOACs）在肥胖房颤患者中的有效性和安全性。两位作者独立进行了全面的文献检索，使用了包括PubMed、CINAHL和EMBASE在内的电子数据库，检索时间从数据库建立至2023年6月1日。本荟萃分析中评估的疗效结果包括中风和全身性栓塞的综合情况。对于安全性分析，比较了各研究组中的大出血事件。11项研究符合所有纳入标准，被纳入本荟萃分析，共纳入144,502名患者。在本研究中，与华法林相比，DOACs在预防中风/全身性栓塞方面显示出更高的疗效。在DOACs中，阿哌沙班被证明是最有效的，其次是利伐沙班、华法林和达比加群。在安全性方面，阿哌沙班也被发现是最有利的治疗选择，其次是利伐沙班、达比加群和华法林。总之，我们的研究得出结论，在肥胖房颤患者中，与其他DOACs和华法林相比，阿哌沙班表现出更高的有效性和安全性。
