Darzé Beatriz Rocha, Borges Queila Oliveira, Viana Mateus S, Darzé Eduardo Sahade, Ritt Luiz Eduardo Fonteles
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil.
D'Or Research Institute, IDOR, Hospital Cardio Pulmonar, Salvador, BA - Brasil.
Arq Bras Cardiol. 2025 Apr;122(4):e20240544. doi: 10.36660/abc.20240544.
Obese individuals have been historically underrepresented in clinical trials. Considering their association with a higher risk of venous thromboembolism (VTE) and acute coronary syndrome (ACS), it is necessary to establish a more suitable anticoagulation regimen for this group of patients.
To evaluate the influence of obesity on the safety and efficacy of antithrombotic therapy in patients with ACS or VTE.
This is a systematic review and meta-analysis that used 5 main international databases. We selected clinical trials or observational studies that compared the occurrence of clinical outcomes (mortality or bleeding) between obese and non-obese patients using parenteral anticoagulants for the treatment of ACS or VTE. P value < 0.05 was used for all analyses.
Six articles, with a total of 40,939 patients, were eligible, being 3 randomized clinical trials and 3 retrospective cohorts. Of the patients, 87.7% had ACS. The incidence of major bleeding was similar between groups (relative risk [RR]: 0.90, 95% confidence interval [CI]: 0.77 to 1.04, p = 0.14). The outcome remained comparable when studies were analyzed separately by anticoagulant: enoxaparin (RR: 0.87, 95% CI, 0.70 to 1.08, p = 0.21) or unfractionated heparin (RR: 0.96, 95% CI, 0.79 to 1.17, p = 0.67). The mortality rate was measured in only 2 studies, both in ACS, and it was lower in obese patients (RR: 0.71, 95% CI 0.59 to 0.87, p = 0.0007).
In patients treated for VTE or ACS, rates of bleeding were comparable between obese and non-obese patients, regardless of the anticoagulant used. The lower mortality rate observed in obese patients may represent the effect of unaccounted confounding.
肥胖个体在临床试验中的代表性历来不足。鉴于他们与静脉血栓栓塞症（VTE）和急性冠状动脉综合征（ACS）的较高风险相关，有必要为这组患者建立更合适的抗凝方案。
评估肥胖对ACS或VTE患者抗栓治疗安全性和有效性的影响。
这是一项系统评价和荟萃分析，使用了5个主要的国际数据库。我们选择了比较使用肠外抗凝剂治疗ACS或VTE的肥胖患者和非肥胖患者临床结局（死亡率或出血）发生率的临床试验或观察性研究。所有分析均采用P值<0.05。
6篇文章符合要求，共纳入40939例患者，其中3项随机临床试验和3项回顾性队列研究。患者中87.7%患有ACS。两组间大出血发生率相似（相对风险[RR]：0.90，95%置信区间[CI]：0.77至1.04，p = 0.14）。按抗凝剂分别分析研究时，结果仍然相当：依诺肝素（RR：0.87，95% CI，0.70至1.08，p = 0.21）或普通肝素（RR：0.96，95% CI，0.79至1.17，p = 0.67）。仅在2项ACS研究中测量了死亡率，肥胖患者的死亡率较低（RR：0.71，95% CI 0.59至0.87，p = 0.0007）。
在接受VTE或ACS治疗的患者中，无论使用何种抗凝剂，肥胖患者和非肥胖患者的出血率相当。肥胖患者中观察到的较低死亡率可能代表未考虑到的混杂因素的影响。
