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

• Published in: Thrombosis research Vol. 233; pp. 165 - 172
• Main Authors: Rueda-Camino, José Antonio, Barba, Raquel, Otálora, Sonia, Bura-Riviere, Alessandra, Visonà, Adriana, Mahé, Isabelle, Alda-Lozano, Alicia, Alfonso Megido, Joaquín, Pacheco-Gómez, Nazaret, Rosovsky, Rachel P, Monreal, Manuel
• Format: Journal Article
• Language: English
• Published: United States 01-01-2024
• Subjects: Administration, Oral; Anticoagulants - adverse effects; Factor Xa Inhibitors - therapeutic use; Female; Hemorrhage - drug therapy; Humans; Male; Middle Aged; Obesity - complications; Obesity - drug therapy; Rivaroxaban - therapeutic use; Venous Thromboembolism - complications; Obesity; Dabigatran; Hemorrhage; Factor Xa inhibitors; Venous thromboembolism
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2023.12.001

There is scarce evidence on the effectiveness and safety of recommended-dose direct acting oral anticoagulants (DOACs) in obese patients with venous thromboembolism (VTE).
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/m
(obese) vs. those with BMI 18.5-24.9 kg/m
(normal weight). We performed regression models with competing risks for death.
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).
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.