Non-vitamin K antagonist oral anticoagulant for atrial fibrillation in obese patients
SY Wang, RP Giugliano - The American Journal of Cardiology, 2020 - Elsevier
SY Wang, RP Giugliano
The American Journal of Cardiology, 2020•ElsevierHighlights•Obesity is an important risk factor for atrial fibrillation.•Despite “obesity paradox”
in atrial fibrillation, patient weight loss preferred.•Oral anticoagulants may be more
efficacious in patients with higher body mass indices.•Similar efficacy/safety with novel
anticoagulants versus warfarin in obese patients.Four non-vitamin K antagonist oral
anticoagulants (NOACs) are approved for use to reduce the risk of stroke and systemic
embolism in patients with atrial fibrillation (AF). However, data are limited regarding the use …
in atrial fibrillation, patient weight loss preferred.•Oral anticoagulants may be more
efficacious in patients with higher body mass indices.•Similar efficacy/safety with novel
anticoagulants versus warfarin in obese patients.Four non-vitamin K antagonist oral
anticoagulants (NOACs) are approved for use to reduce the risk of stroke and systemic
embolism in patients with atrial fibrillation (AF). However, data are limited regarding the use …
Highlights
- Obesity is an important risk factor for atrial fibrillation.
- Despite “obesity paradox” in atrial fibrillation, patient weight loss preferred.
- Oral anticoagulants may be more efficacious in patients with higher body mass indices.
- Similar efficacy/safety with novel anticoagulants versus warfarin in obese patients.
Four non-vitamin K antagonist oral anticoagulants (NOACs) are approved for use to reduce the risk of stroke and systemic embolism in patients with atrial fibrillation (AF). However, data are limited regarding the use of NOACs in the obese population. This manuscript summarizes current concepts regarding obesity in patients with AF and reviews in depth the data on the efficacy and safety of NOACs in obese patients with AF. The Pubmed database was searched for relevant articles. When evaluating obese patients with AF, weight loss is important to reduce disease burden. Recent analyses of the four NOAC versus warfarin trials (RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE AF-TIMI 48) stratified by body mass index (BMI) demonstrate preserved efficacy with NOACs versus warfarin in obese patients, with similar risk of major bleeding. Although the data are limited in class III obese patients (body mass index≥ 40kg/m 2), the efficacy and safety of apixaban or edoxaban appears to be similar to warfarin in patients with BMI 40-50kg/m 2. In conclusion, these new data should be considered in updated guidelines, which currently provide limited, and sometimes conflicting recommendations regarding the use of NOACs in obese patients, particularly in severely obese patients.
Elsevier
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