Real life results of direct-acting oral anticoagulants recommended-dose in obese vs normal-weight patients with venous thromboembolism

被引:4
作者
Rueda-Camino, Jose Antonio [1 ,2 ,14 ]
Barba, Raquel [1 ,2 ]
Otalora, Sonia [3 ]
Bura-Riviere, Alessandra [4 ]
Visona, Adriana [5 ]
Mahe, Isabelle [6 ,7 ]
Alda-Lozano, Alicia [8 ]
Megido, Joaquin Alfonso [9 ]
Pacheco-Gomez, Nazaret [10 ]
Rosovsky, Rachel P. [11 ]
Monreal, Manuel [12 ,13 ]
机构
[1] Hosp Univ Rey Juan Carlos, Dept Internal Med, Madrid, Spain
[2] Hlth Res Inst Fdn Jimenez Diaz, Madrid, Spain
[3] Hosp Univ Virgen de Arrixaca, Dept Internal Med, Murcia, Spain
[4] Hop Rangueil, Dept Vasc Med, Toulouse, France
[5] Osped Castelfranco Veneto, Dept Vasc Med, Castelfranco Veneto, Italy
[6] Hop Louis Mourier, Assistance Publ Hop Paris AP HP, Dept Internal Med, Colombes, France
[7] Univ Paris Cite, INSERM, UMR S 1140, Paris, France
[8] Hosp Reina Sofia, Dept Internal Med, Tudela, Navarra, Spain
[9] Hosp Valle del Nalon, Dept Internal Med, Sama De Langreo, Asturias, Spain
[10] San Pedro Hosp de Alcantara, Dept Internal Med, Caceres, Spain
[11] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Boston, MA USA
[12] UCAM Univ Catolica San Antonio Murcia, Fac Hlth Sci, Chair Study Thromboembol Dis, Murcia, Spain
[13] CIBER Enfermedades Resp CIBERES, Madrid, Spain
[14] Hosp Univ Rey Juan Carlos, Hlth Res Inst Fdn Jimenez Diaz, Dept Internal Med, C Gladiolo S-N, Madrid 28933, Spain
关键词
Venous thromboembolism; Obesity; Factor Xa inhibitors; Dabigatran; Hemorrhage; RISK-FACTORS; BODY-WEIGHT; PULMONARY-EMBOLISM; RIVAROXABAN; PHARMACOKINETICS; APIXABAN; PHARMACODYNAMICS; TOLERABILITY; MORTALITY; EXTREMES;
D O I
10.1016/j.thromres.2023.12.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: There is scarce evidence on the effectiveness and safety of recommended-dose direct acting oral anticoagulants (DOACs) in obese patients with venous thromboembolism (VTE). Material and methods: We used the data in the RIETE registry to compare the rates of VTE recurrences and major bleeding during long-term therapy with DOACs at recommended doses in patients with body mass index >= 30 kg/ m2 (obese) vs. those with BMI 18.5-24.9 kg/m2 (normal weight). We performed regression models with competing risks for death. Results: From January 2013 through October 2022, 2885 obese patients and 2676 with normal weight in RIETE received rivaroxaban (n = 3020), apixaban (n =1754), edoxaban (n = 636) or dabigatran (n = 151). Median age was 63 years and 52 % were female. At baseline, obese patients were more likely to have diabetes (18.6 % vs. 8.4 %), hypertension (51.9 % vs. 31.4 %) or pulmonary embolism (67.7 % vs. 61 %), and less likely to have renal insufficiency (5.3 % vs. 16 %) or anaemia (21.8 % vs. 28 %%). During anticoagulation (median, 147 vs. 101 days), the obese had a similar rate of VTE recurrences (1.71 vs. 2.14 events per 100 patients-years; hazard ratio (HR): 0.81; 95 % CI: 0.49-1.34) or major bleeding (1.45 vs. 1.76 per 100 patients-years; HR: 0.91; 95 % CI: 0.52-1.59) than those with normal weight. These findings persisted after multivariable analysis (recurrent VTE, HR: 0.80; 95 % CI: 0.48-1.32; major bleeding, HR: 1.11; 95 % CI: 0.60-2.07). Conclusion: The use of DOACs at recommended doses in obese patients with VTE was associated with similar rates of VTE recurrences or major bleeding than in patients with normal weight.
引用
收藏
页码:165 / 172
页数:8
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