Retrospective, multicenter analysis of the safety and effectiveness of direct oral anticoagulants for the treatment of venous thromboembolism in obesity.

Autor: Sperry JD; UC Health Memorial Hospital, Department of Pharmacy, Colorado Springs, CO, USA., Loeb A; Department of Pharmacy, University of California, Davis, Sacramento, CA, USA., Smith MJ; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA., Brighton TB; Department of Pharmacy, University of Massachusetts Chan Medical School, Worcester, MA, USA., Ehret JA; Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA., Fermo JD; Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA., Gentili ME; Department of Pharmacy Services, Beth Israel Lahey Health, Burlington, MA, USA., Lancaster JW; School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, USA., Mazur JN; Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA., Spezzano K; Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY, USA., Szwak JA; Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA. jszwak1@jhmi.edu.
Jazyk: angličtina
Zdroj: Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2024 Apr; Vol. 57 (4), pp. 603-612. Date of Electronic Publication: 2024 Feb 26.
DOI: 10.1007/s11239-024-02955-6
Abstrakt: Background: Direct oral anticoagulants (DOACs) are the preferred treatment for venous thromboembolism (VTE). However, DOAC use in patients with a BMI greater than 40 kg/m 2 has not been well studied despite the growing prevalence of obesity, and current literature is often underpowered.
Methods: This multicenter, retrospective, observational study evaluated patients 18 years and older who received DOACs for acute VTE treatment. Patients receiving DOACs for recurrent VTE or for failure of another agent were excluded. The primary efficacy outcome was recurrent VTE and the primary safety outcome was major bleeding within 12 months (or one month after stopping anticoagulation therapy). A propensity score analysis was performed to balance patient characteristics and evaluate the primary endpoints by BMI group. Time-to-event outcomes were analyzed using weighted Kaplan-Meier curves.
Results: There were 165 patients with a BMI of at least 40 kg/m 2 and 320 patients with a BMI less than 40 kg/m 2 . The majority received apixaban (373, 77%). Recurrent VTE occurred in 5 (3.0%) and 13 (4.1%) of patients in the higher and lower BMI groups, respectively (adjusted OR: 0.66; 95% CI: 0.16-2.69). Major bleeding occurred in 5 (3.0%) and 15 (4.7%) of patients in the higher and lower BMI groups, respectively (adjusted OR: 1.19; 95% CI: 0.36-3.92).
Conclusion: There was no significant difference in VTE recurrence or major bleeding related to BMI among patients treated with DOACs. This study showed that DOACs may be a safe and effective VTE treatment option in patients with obesity.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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