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Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Weighing ≥ 120 Kilograms versus 60–120 Kilograms
Background Direct oral anticoagulants (DOACs) have become favorable choices for anticoagulation due to their fixed-dose schedule, limited need for monitoring, and non-inferiority or superiority to warfarin. DOACs are currently not recommended in patients with a body weight ≥ 120 kg or body mass inde...
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| Published in: | American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2021-09, Vol.21 (5), p.545-551 |
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| container_issue | 5 |
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| container_title | American journal of cardiovascular drugs : drugs, devices, and other interventions |
| container_volume | 21 |
| creator | Wiethorn, Eryne E. Bell, Carolyn Magee Wiggins, Barbara S. |
| description | Background
Direct oral anticoagulants (DOACs) have become favorable choices for anticoagulation due to their fixed-dose schedule, limited need for monitoring, and non-inferiority or superiority to warfarin. DOACs are currently not recommended in patients with a body weight ≥ 120 kg or body mass index ≥ 40 kg/m
2
due to limited data regarding safety and efficacy.
Objective
The aim of this study was to compare the safety and efficacy of DOACs in patients with nonvalvular atrial fibrillation (NVAF) and weighing ≥ 120 kg with those weighing |
| doi_str_mv | 10.1007/s40256-021-00470-0 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2574464261</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2574464261</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-7cf7a6610265ebb2edbf988ae2661a14f8b9661ee2fd0d6dae711b56bc5f69413</originalsourceid><addsrcrecordid>eNp9kbtOwzAUhiMEEtcXYLLEHDh2E7sZq1IuAgESINgsJzkORqlTbLeIjZWZF2DhxXgS3BYJsTD5l__LGb4k2aWwTwHEgc-A5TwFRlOATEAKK8kGpaJIaV_cry50nvaYEOvJpvePAFQwUWwkHyOtsQpmhha9J8rW5FppDC-k0-TQuOiRS6daMrDBVJ1qpq2ywRNjyZUKBuf62YQHctHZmWpn0XZkEJyJlSNTOtO2MdbZxfIdmubB2IZ8vX0SyoCcmbZrnBp7MkPnp55w-Hp9_-NsJ2tatR53ft6t5PZodDM8Sc8vj0-Hg_O06ok8pKLSQnFOgfEcy5JhXeqi31fI4qeime6XRVSITNdQ81qhoLTMeVnlmhcZ7W0le8vdieuepuiDfOymzsaTkuUiy3jG-DzFlqnKdd471HLizFi5F0lBzknIJQkZScgFCQmx1FuWfAzbBt3v9D-tb7Oej2M</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2574464261</pqid></control><display><type>article</type><title>Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Weighing ≥ 120 Kilograms versus 60–120 Kilograms</title><source>Nexis UK</source><source>Springer Nature</source><creator>Wiethorn, Eryne E. ; Bell, Carolyn Magee ; Wiggins, Barbara S.</creator><creatorcontrib>Wiethorn, Eryne E. ; Bell, Carolyn Magee ; Wiggins, Barbara S.</creatorcontrib><description>Background
Direct oral anticoagulants (DOACs) have become favorable choices for anticoagulation due to their fixed-dose schedule, limited need for monitoring, and non-inferiority or superiority to warfarin. DOACs are currently not recommended in patients with a body weight ≥ 120 kg or body mass index ≥ 40 kg/m
2
due to limited data regarding safety and efficacy.
Objective
The aim of this study was to compare the safety and efficacy of DOACs in patients with nonvalvular atrial fibrillation (NVAF) and weighing ≥ 120 kg with those weighing < 120 kg.
Methods
A single-center, retrospective study was conducted in patients weighing ≥ 120 kg who received either apixaban, dabigatran, or rivaroxaban for stroke risk reduction in NVAF, and matched to patients who weighed < 120 kg. The primary outcome was the incidence of stroke, deep vein thrombosis, pulmonary embolism, or myocardial infarction, while the safety outcome was the incidence of major or clinically relevant non-major bleeding based on the International Society on Thrombosis and Haemostasis (ISTH) definitions.
Results
A total of 318 patients weighing ≥ 120 kg with NVAF and meeting the inclusion criteria were evaluated and matched with 318 patients weighing < 120 kg. The primary outcome occurred in 2.5% of patients in the ≥ 120 kg group and in 3.1% of patients in the < 120 kg group (
p
= 0.632). The safety outcome occurred in 5.3% and 6.6% of patients in these respective groups (
p
= 0.503).
Conclusion
Apixaban, dabigatran, or rivaroxaban may be well-tolerated and effective anticoagulant options in patients with NVAF weighing ≥ 120 kg.</description><identifier>ISSN: 1175-3277</identifier><identifier>EISSN: 1179-187X</identifier><identifier>DOI: 10.1007/s40256-021-00470-0</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Age ; Anticoagulants ; Body mass index ; Cardiac arrhythmia ; Cardiology ; Clinical trials ; Drug dosages ; Ethnicity ; Heart attacks ; Hospitals ; Medicine ; Medicine & Public Health ; Original Research Article ; Patients ; Pharmacology/Toxicology ; Pharmacotherapy ; Pulmonary embolisms ; Stroke ; Thrombosis ; Veins & arteries</subject><ispartof>American journal of cardiovascular drugs : drugs, devices, and other interventions, 2021-09, Vol.21 (5), p.545-551</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature 2021</rights><rights>Copyright Springer Nature B.V. Sep 2021</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-7cf7a6610265ebb2edbf988ae2661a14f8b9661ee2fd0d6dae711b56bc5f69413</citedby><cites>FETCH-LOGICAL-c375t-7cf7a6610265ebb2edbf988ae2661a14f8b9661ee2fd0d6dae711b56bc5f69413</cites><orcidid>0000-0002-4184-8505 ; 0000-0003-4988-7485 ; 0000-0001-7024-9934</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids></links><search><creatorcontrib>Wiethorn, Eryne E.</creatorcontrib><creatorcontrib>Bell, Carolyn Magee</creatorcontrib><creatorcontrib>Wiggins, Barbara S.</creatorcontrib><title>Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Weighing ≥ 120 Kilograms versus 60–120 Kilograms</title><title>American journal of cardiovascular drugs : drugs, devices, and other interventions</title><addtitle>Am J Cardiovasc Drugs</addtitle><description>Background
Direct oral anticoagulants (DOACs) have become favorable choices for anticoagulation due to their fixed-dose schedule, limited need for monitoring, and non-inferiority or superiority to warfarin. DOACs are currently not recommended in patients with a body weight ≥ 120 kg or body mass index ≥ 40 kg/m
2
due to limited data regarding safety and efficacy.
Objective
The aim of this study was to compare the safety and efficacy of DOACs in patients with nonvalvular atrial fibrillation (NVAF) and weighing ≥ 120 kg with those weighing < 120 kg.
Methods
A single-center, retrospective study was conducted in patients weighing ≥ 120 kg who received either apixaban, dabigatran, or rivaroxaban for stroke risk reduction in NVAF, and matched to patients who weighed < 120 kg. The primary outcome was the incidence of stroke, deep vein thrombosis, pulmonary embolism, or myocardial infarction, while the safety outcome was the incidence of major or clinically relevant non-major bleeding based on the International Society on Thrombosis and Haemostasis (ISTH) definitions.
Results
A total of 318 patients weighing ≥ 120 kg with NVAF and meeting the inclusion criteria were evaluated and matched with 318 patients weighing < 120 kg. The primary outcome occurred in 2.5% of patients in the ≥ 120 kg group and in 3.1% of patients in the < 120 kg group (
p
= 0.632). The safety outcome occurred in 5.3% and 6.6% of patients in these respective groups (
p
= 0.503).
Conclusion
Apixaban, dabigatran, or rivaroxaban may be well-tolerated and effective anticoagulant options in patients with NVAF weighing ≥ 120 kg.</description><subject>Age</subject><subject>Anticoagulants</subject><subject>Body mass index</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Clinical trials</subject><subject>Drug dosages</subject><subject>Ethnicity</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research Article</subject><subject>Patients</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Pulmonary embolisms</subject><subject>Stroke</subject><subject>Thrombosis</subject><subject>Veins & arteries</subject><issn>1175-3277</issn><issn>1179-187X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kbtOwzAUhiMEEtcXYLLEHDh2E7sZq1IuAgESINgsJzkORqlTbLeIjZWZF2DhxXgS3BYJsTD5l__LGb4k2aWwTwHEgc-A5TwFRlOATEAKK8kGpaJIaV_cry50nvaYEOvJpvePAFQwUWwkHyOtsQpmhha9J8rW5FppDC-k0-TQuOiRS6daMrDBVJ1qpq2ywRNjyZUKBuf62YQHctHZmWpn0XZkEJyJlSNTOtO2MdbZxfIdmubB2IZ8vX0SyoCcmbZrnBp7MkPnp55w-Hp9_-NsJ2tatR53ft6t5PZodDM8Sc8vj0-Hg_O06ok8pKLSQnFOgfEcy5JhXeqi31fI4qeime6XRVSITNdQ81qhoLTMeVnlmhcZ7W0le8vdieuepuiDfOymzsaTkuUiy3jG-DzFlqnKdd471HLizFi5F0lBzknIJQkZScgFCQmx1FuWfAzbBt3v9D-tb7Oej2M</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Wiethorn, Eryne E.</creator><creator>Bell, Carolyn Magee</creator><creator>Wiggins, Barbara S.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><orcidid>https://orcid.org/0000-0002-4184-8505</orcidid><orcidid>https://orcid.org/0000-0003-4988-7485</orcidid><orcidid>https://orcid.org/0000-0001-7024-9934</orcidid></search><sort><creationdate>20210901</creationdate><title>Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Weighing ≥ 120 Kilograms versus 60–120 Kilograms</title><author>Wiethorn, Eryne E. ; Bell, Carolyn Magee ; Wiggins, Barbara S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-7cf7a6610265ebb2edbf988ae2661a14f8b9661ee2fd0d6dae711b56bc5f69413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Age</topic><topic>Anticoagulants</topic><topic>Body mass index</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Clinical trials</topic><topic>Drug dosages</topic><topic>Ethnicity</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research Article</topic><topic>Patients</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Pulmonary embolisms</topic><topic>Stroke</topic><topic>Thrombosis</topic><topic>Veins & arteries</topic><toplevel>online_resources</toplevel><creatorcontrib>Wiethorn, Eryne E.</creatorcontrib><creatorcontrib>Bell, Carolyn Magee</creatorcontrib><creatorcontrib>Wiggins, Barbara S.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wiethorn, Eryne E.</au><au>Bell, Carolyn Magee</au><au>Wiggins, Barbara S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Weighing ≥ 120 Kilograms versus 60–120 Kilograms</atitle><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle><stitle>Am J Cardiovasc Drugs</stitle><date>2021-09-01</date><risdate>2021</risdate><volume>21</volume><issue>5</issue><spage>545</spage><epage>551</epage><pages>545-551</pages><issn>1175-3277</issn><eissn>1179-187X</eissn><abstract>Background
Direct oral anticoagulants (DOACs) have become favorable choices for anticoagulation due to their fixed-dose schedule, limited need for monitoring, and non-inferiority or superiority to warfarin. DOACs are currently not recommended in patients with a body weight ≥ 120 kg or body mass index ≥ 40 kg/m
2
due to limited data regarding safety and efficacy.
Objective
The aim of this study was to compare the safety and efficacy of DOACs in patients with nonvalvular atrial fibrillation (NVAF) and weighing ≥ 120 kg with those weighing < 120 kg.
Methods
A single-center, retrospective study was conducted in patients weighing ≥ 120 kg who received either apixaban, dabigatran, or rivaroxaban for stroke risk reduction in NVAF, and matched to patients who weighed < 120 kg. The primary outcome was the incidence of stroke, deep vein thrombosis, pulmonary embolism, or myocardial infarction, while the safety outcome was the incidence of major or clinically relevant non-major bleeding based on the International Society on Thrombosis and Haemostasis (ISTH) definitions.
Results
A total of 318 patients weighing ≥ 120 kg with NVAF and meeting the inclusion criteria were evaluated and matched with 318 patients weighing < 120 kg. The primary outcome occurred in 2.5% of patients in the ≥ 120 kg group and in 3.1% of patients in the < 120 kg group (
p
= 0.632). The safety outcome occurred in 5.3% and 6.6% of patients in these respective groups (
p
= 0.503).
Conclusion
Apixaban, dabigatran, or rivaroxaban may be well-tolerated and effective anticoagulant options in patients with NVAF weighing ≥ 120 kg.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><doi>10.1007/s40256-021-00470-0</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-4184-8505</orcidid><orcidid>https://orcid.org/0000-0003-4988-7485</orcidid><orcidid>https://orcid.org/0000-0001-7024-9934</orcidid></addata></record> |
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| identifier | ISSN: 1175-3277 |
| ispartof | American journal of cardiovascular drugs : drugs, devices, and other interventions, 2021-09, Vol.21 (5), p.545-551 |
| issn | 1175-3277 1179-187X |
| language | eng |
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| source | Nexis UK; Springer Nature |
| subjects | Age Anticoagulants Body mass index Cardiac arrhythmia Cardiology Clinical trials Drug dosages Ethnicity Heart attacks Hospitals Medicine Medicine & Public Health Original Research Article Patients Pharmacology/Toxicology Pharmacotherapy Pulmonary embolisms Stroke Thrombosis Veins & arteries |
| title | Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Weighing ≥ 120 Kilograms versus 60–120 Kilograms |
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