Rivaroxaban versus warfarin treatment among morbidly obese patients with venous thromboembolism: Comparative effectiveness, safety, and costs

Spyropoulos, Alex C.; Ashton, Veronica; Chen, Yen Wen; Wu, Bingcao; Peterson, Eric D.

doi:10.1016/j.thromres.2019.08.021

Cited by 57 publications

(76 citation statements)

References 32 publications

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“…Our use of codes for DVT and PE events is supported by a prior review that found high positive predictive values (65–95%) for identifying VTE events . Our VTE recurrence rates were higher (~6%) than those reported in one study (1–2%) but less than half the rates observed by another report (16–17%) . These differences may be attributed primarily due to the study designs and sources of data.…”

Section: Discussionsupporting

confidence: 74%

“…With regard to safety, we found no significant difference in bleeding between treatment groups. Our major bleeding definition used a validated algorithm and was consistent with the approach used by others . Our bleeding event rates were similar to those reported by each of the prior studies (~1–2%) …”

Section: Discussionsupporting

confidence: 74%

“…We found no significant difference in VTE recurrence between groups regardless of treatment acuity, thus providing insight on differences in patient populations at varying thrombotic risks. Prior studies only included those who were newly started on anticoagulation . With regard to safety, we found no significant difference in bleeding between treatment groups.…”

Section: Discussionmentioning

confidence: 63%

“…A total of 2890 matched pairs of patients had similar VTE recurrence rates in the intention‐to‐treat (ITT) population (rivaroxaban 16.8% vs warfarin 15.9%; p=0.84). The rate of major bleeding was significantly different in the ITT analysis (rivaroxaban 1.8% vs warfarin 2.5%; p=0.04) but was not significantly different in the on‐treatment analysis . Time in therapeutic range was not able to be determined for either study.…”

Section: Discussionmentioning

confidence: 89%

“…This study was distinctive in that it had a high proportion of African American and Hispanic patients, so results may not be generalizable to whites and other populations. Another study used a claims database to evaluate patients retrospectively who had an ICD code for morbid obesity and who had a new prescription claim for rivaroxaban or warfarin . A total of 2890 matched pairs of patients had similar VTE recurrence rates in the intention‐to‐treat (ITT) population (rivaroxaban 16.8% vs warfarin 15.9%; p=0.84).…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

et al. 2020

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Study Objective Studies on the use of direct oral anticoagulants (DOACs) in obese patients are limited. Current guidelines advise against DOAC use in patients with a body weight more than 120 kg or body mass index higher than 40 kg/m2. Therefore, the aim of this study was to evaluate the effectiveness and safety of DOACs versus warfarin for the treatment of acute venous thromboembolism (VTE) in obese patients. Design Retrospective matched cohort study. Setting Integrated delivery system of 40 academic, community, and specialty hospitals. Patients A total of 1840 adults with a primary admission diagnosis of acute VTE who received a DOAC (apixaban, dabigatran, or rivaroxaban [632 patients] or warfarin [1208 patients]) while hospitalized between January 1, 2011, and October 1, 2015, and who had a body weight more than 100 kg and less than 300 kg, were included. Patients in the warfarin group were matched in a 2:1 ratio to patients who received a DOAC based on history of VTE, chronic kidney disease, race, and age. Measurements and Main Results The primary outcome was recurrence of VTE within 12 months of the index admission date. Secondary outcomes included occurrence of pulmonary embolism (PE) and deep vein thrombosis (DVT) events separately within the study time frame, as well as bleeding within 12 months of the index admission date. No significant difference in the recurrence of VTE was observed between patients who received a DOAC compared with those who received warfarin (6.5% vs 6.4%, p=0.93). Likewise, no significant differences in the occurrence of PE and DVT were seen between the DOAC‐ and warfarin‐treated patients (3.7% vs 3.8%, p=0.94, and 3% vs 3.5%, p=0.56, respectively). Bleeding occurred in 1.7% and 1.2% of patients in the DOAC and warfarin groups, respectively (p=0.31). Conclusion To our knowledge, this is the largest clinical study to date showing that patients with obesity can be treated effectively and safely with a DOAC compared with warfarin for acute VTE. Thus DOACs should be considered a reasonable alternative to warfarin for treatment of acute VTE in obese patients.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

et al. 2020

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Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

et al. 2023

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Aims Prior studies have suggested causal relationships between obesity and acute cardiovascular events. It has been also known that the risk of acute cardiovascular events is reduced by bariatric surgery. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy (HCM). In this context, we aimed to investigate whether bariatric surgery is associated with a reduced risk of cardiovascular‐related acute care use in patients with HCM. Methods and results In this population‐based study, the bariatric surgery group consisted of patients with HCM who underwent bariatric surgery from January 2004 to December 2014. The control group included those who have obesity and HCM and received non‐bariatric elective intra‐abdominal surgery during the same period. The outcome was cardiovascular‐related acute care use (i.e. emergency department (ED) visits or unplanned hospitalizations for cardiovascular disease) during a 1‐year post‐surgery period. We used the SPARCS database, a population‐based ED and inpatient database in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6‐month post‐surgery periods. We adjusted for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2 years before the index surgery, and the Elixhauser co‐morbidity measures. We also performed propensity score (PS)‐matching and inverse probability treatment weighting analyses using these variables. The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 in the control group. The risk was not significantly different in the 1–6 months post‐surgery period. By contrast, in the 7–12 months post‐surgery period, the risk of cardiovascular‐related acute care use was significantly lower in the bariatric surgery group (adjusted odds ratio 0.23; 95% CI 0.068–0.71; P = 0.01) compared with the control group. In the PS‐matched cohort, there were no significant differences in the baseline characteristics. The PS‐matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7–12 months post‐surgery period. The inverse probability treatment weighting analysis replicated the findings. Conclusions Bariatric surgery was associated with a lower risk of cardiovascular‐related acute care use in the 7–12 months post‐surgery period in this population‐based study.

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Comparing direct oral anticoagulants and vitamin K antagonist use in morbidly obese patients with venous thromboembolism: A single center retrospective cohort study

Scott

Cafuir

et al. 2022

eJHaem

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Introduction: Limited data exists on the safety and efficacy of direct‐acting oral anticoagulants (DOAC) use in morbidly obese patients with venous thromboembolism (VTE). Given the benefits of DOAC use over vitamin K antagonists (VKAs), in terms of monitoring requirements, and dietary and drug interactions, it is important to evaluate whether this is consistent in the higher risk for VTE recurrence morbidly obese group body mass index (BMI ≥ 40 kg/m2). Materials and methods: This retrospective, single‐center cohort study included patients with a BMI of at least 40 kg/m2 who were admitted to Emory University Hospital from 1st January 2012 to 31st May 2020 with acute VTE, and subsequently initiated on anticoagulation treatment with either DOAC or VKA (warfarin). Univariate and bivariate analyses were used to evaluate differences in demographics by treatment type and BMI. Multivariate Cox proportional hazard regression was used to assess the risk of VTE recurrence by type of treatment among morbidly obese patient subgroup. Results: There were 247 (11.8%) morbidly obese (≥ 40 kg/m2) patients who were more likely than non‐obese patients to be younger, female, and of non‐white race. Thirty percent of the study population (n=74) had a BMI >50 kg/m2. T ime‐to‐event analysis confirmed that the hazard of experiencing a recurrent thrombosis was not statistically significantly different among morbidly obese patients treated with a DOAC compared with VKA (hazard ratio [HR]: 0.28, confidence interval [CI] 0.07‐1.11, p = 0.07). Conclusions: This study aligns with previous literature and confirms that morbidly obese patients receiving DOAC or VKA have similar risks of recurrent VTE.

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Rivaroxaban versus warfarin treatment among morbidly obese patients with venous thromboembolism: Comparative effectiveness, safety, and costs

Cited by 57 publications

References 32 publications

Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients with Acute Venous Thromboembolism

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

Comparing direct oral anticoagulants and vitamin K antagonist use in morbidly obese patients with venous thromboembolism: A single center retrospective cohort study

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