DOACs use in extreme body-weighted patients: results from the prospective START-register.

Autor: Guarascio M; Vito Fazzi Hospital, U.O. Medicina Interna, Lecce, Italy. guarasciomatteo@gmail.com., Bertù L; Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, Varese, Italy., Donadini MP; Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, Varese, Italy.; Emergency Medicine and Thrombosis and Haemostasis Center, ASST Sette Laghi, Varese, Italy., Antonucci E; Arianna Anticoagulazione Foundation, Bologna, Italy., Palareti G; Arianna Anticoagulazione Foundation, Bologna, Italy., Ageno W; Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, Varese, Italy.; Emergency Medicine and Thrombosis and Haemostasis Center, ASST Sette Laghi, Varese, Italy.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2023 Sep; Vol. 18 (6), pp. 1681-1687. Date of Electronic Publication: 2023 Jun 10.
DOI: 10.1007/s11739-023-03334-4
Abstrakt: Background: Direct oral anticoagulants (DOACs) are widely used for the treatment of venous thromboembolism (VTE) and for stroke prevention in atrial fibrillation (AF). However, evidence in obese and underweight patients is limited. We assessed the safety and effectiveness of DOACs and vitamin K antagonists (VKAs) in patients  ≥ 120 kg or ≤ 50 kg enrolled in an observational prospective cohort study, the START-Register.
Methods: Adult patients started on anticoagulant therapy were followed up for a median of 1.5 years (IQR 0.6-2.8). Primary efficacy outcome was the occurrence of VTE recurrence, stroke and systemic embolism. Primary safety outcome was major bleeding (MB).
Results: 10,080 AF and VTE patients were enrolled between March 2011 and June 2021, 295 patients weighted  ≤ 50 kg and 82 patients ≥ 120 kg. Obese patients were significantly younger than underweight patients. Rates of thrombotic events were low and similar between DOACs and VKAs in underweight patients (1 event on DOACs therapy [0.9% 95% CI 0.11-5.39] and 2 on VKAs [1.1% 95% CI 0.01-47.68]) and in overweight patients (0 events on DOACs, 1 on VKAs [1.6%, 95% CI 0.11-5.79]. Two MB events occurred on DOACs (1.9%, 95% CI 0.38-6.00) and 3 on VKAs (1.6%, 95% CI 0.04-22.06) in the underweight group; 1 MB on DOACs (5.3% 95% CI 0.33-16.68) and 2 on VKAs (3.3%, 95% CI 0.02-130.77) in the overweight group.
Conclusions: DOACs seem to be effective and safe also for the treatment of patients with extreme body weights, both underweight and overweight. Further prospective studies are needed to support these findings.
(© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
Databáze: MEDLINE
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