Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies

Patti, Giuseppe; Pecen, Ladislav; Manu, Marius Constantin; Huber, Kurt; Rohla, Miklós; Renda, Giulia; Siller‐Matula, Jolanta M.; Ricci, Fabrizio; Kirchhof, Paulus; Caterina, Raffaele De

doi:10.1016/j.ijcard.2020.06.010

Cited by 12 publications

(14 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, classification of patients according to BMI differed between studies. For example, some studies categorized their patient cohorts according to the BMI tertiles 31,32 or quartiles, 26 or did not use the WHO BMI classification 30 . Second, BMI was usually measured at baseline, not adjusting for weight changes during follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…Similar major bleeding risks were observed in (morbidly) obese versus normal BMI patients in the ROCKET AF, 7 ARISTOTLE 8 and ENGAGE AF-TIMI 48 trial, 9 as well as in underweight AF patients. 9 After pooling results, a significantly lower odds of major bleeding in obese versus normal BMI AF patients was observed in the meta-analysis of Proietti et al, 10 while this was not the case in the meta-analysis of Zhou et al 15 Similar conflicting results were also present in observational studies, with no impact of (morbid) obesity 4,16,19,20,[22][23][24][25][26] or underweight 16,20,24 on bleeding outcomes observed in most studies. However, the risk of major bleeding was significantly lower per 1 and 5 kg/m 2 increase in BMI in a Taiwanese 31 and Korean 16 study, respectively.…”

Section: Major Bleedingmentioning

confidence: 90%

“…18 However, in other observational studies, the impact of BMI on AFrelated outcomes was not or less clear, illustrating the general controversy regarding the topic. For example, obesity was associated with similar stroke, 19 stroke/SE, 4,[20][21][22][23] stroke/SE/myocardial infarction, 24 or stroke/ SE/venous thromboembolism 25,26 risks compared to normal BMI AF patients included in the FANTASIIA registry 19 ; ORBIT-AF registry (69%-75% VKA-treated) 4 ; J-RHYTHM registry (86%-91% VKA-treated) 20 ; Danish Diet, Cancer and Health study (19%-24% VKA-treated) 21 ; XAPASS study 24 ; PREFER in AF (PROLONGATION) registries 26 ; the Korean retrospective cohort study by Park et al 22 ; and two U.S. retrospective cohort studies by Kaplan et al 23 and Netley et al 25 Similarly, no significant differences in the risk of ischemic stroke, 16 stroke/SE, 20,22 or stroke/SE/myocardial infarction 24 could be demonstrated in underweight versus normal BMI AF patients in two Korean studies by Lee et al 16 and Park et al, 22 the J-RHYTHM registry 20 and the XAPASS study. 24 In contrast, two observational studies illustrated worse outcomes in obese AF patients.…”

Section: Thromboembolismmentioning

confidence: 99%

See 2 more Smart Citations

The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

Grymonprez

Capiau

Backer

et al. 2021

Clinical Cardiology

View full text Add to dashboard Cite

Although obesity is associated with the development and progression of atrial fibrillation (AF), an obesity paradox may be present, illustrated by seemingly protective effects of obesity on AF‐related outcomes. Body mass index (BMI) has an impact on outcomes in AF patients using oral anticoagulants. After searching Medline and Embase, meta‐analysis of results of four randomized and five observational studies demonstrated significantly lower risks of stroke or systemic embolism (RR 0.80, 95%CI [0.73–0.87]; RR 0.63, 95%CI [0.57–0.70]; and RR 0.42, 95%CI [0.31–0.57], respectively) and all‐cause mortality (RR 0.73, 95%CI [0.64–0.83]; RR 0.61, 95%CI [0.52–0.71]; and RR 0.56, 95%CI [0.47–0.66], respectively) in overweight, obese and morbidly obese anticoagulated AF patients (BMI 25 to <30, ≥30 and ≥40 kg/m2, respectively) compared to normal BMI anticoagulated AF patients (BMI 18.5 to <25 kg/m2). In contrast, thromboembolic (RR 1.92, 95%CI [1.28–2.90]) and mortality (RR 3.57, 95%CI [2.50–5.11]) risks were significantly increased in underweight anticoagulated AF patients (BMI <18.5 kg/m2). In overweight and obese anticoagulated AF patients, the risks of major bleeding (RR 0.86, 95%CI [0.76–0.99]; and RR 0.88, 95%CI [0.79–0.98], respectively) and intracranial bleeding (RR 0.75, 95%CI [0.58–0.97]; and RR 0.57, 95%CI [0.40–0.80], respectively) were also significantly lower compared to normal BMI patients, while similar risks were observed in underweight and morbidly obese patients. This meta‐analysis demonstrated lower thromboembolic and mortality risks with increasing BMI. However, as this paradox was driven by results from randomized studies, while observational studies rendered more conflicting results, these seemingly protective effects should still be interpreted with caution.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Major Bleedingmentioning

confidence: 90%

Section: Thromboembolismmentioning

confidence: 99%

See 1 more Smart Citation

The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

Grymonprez

Capiau

Backer

et al. 2021

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…Contrary to these findings, real word data from the prospective PREFER in AF and PREFER in AF PROLONGATION registries showed no obesity paradox for thromboembolic events in patients with AF [36]. Obese patients were at a higher risk of TEE, and oral anticoagulation was found to reduce the risk of events.…”

Section: Discussionmentioning

confidence: 62%

Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry

Boriani

Caterina

Manu

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Background: Extremes of body weight may alter exposure to non-vitamin K antagonist oral anticoagulants and thereby impact clinical outcomes. This ETNA-AF-Europe sub-analysis assessed 1-year outcomes in routine care patients with atrial fibrillation across a range of body weight groups treated with edoxaban. Methods: ETNA-AF-Europe is a multinational, multicentre, observational study conducted in 825 sites in 10 European countries. Overall, 1310, 5565, 4346 and 1446 enrolled patients were categorised into ≤60 kg, >60–≤80 kg (reference weight group), >80–≤100 kg and >100 kg groups. Results: Patients weighing ≤60 kg were older, more frail and had a higher CHA2DS2-VASc score vs. the other weight groups. The rates of stroke/systemic embolism, major bleeding and ICH were low at 1 year (0.82, 1.05 and 0.24%/year), with no significant differences among weight groups. The annualised event rates of all-cause death were 3.50%/year in the overall population. After adjustment for eGFR and CHA2DS2-VASc score, the risk of all-cause death was significantly higher in extreme weight groups vs. the reference group. Conclusions: Low rates of stroke and bleeding were reported with edoxaban, independent of weight. The risk of all-cause death was higher in extremes of weight vs. the reference group after adjustment for important risk modifiers, thus no obesity paradox was observed.

show abstract

“…This is because of the heightened level of inflammatory cytokines secreted by excess fat. The inflammatory cytokines can prompt tissue factor production on endothelium and monocytes causing coagulation, as blood coming into contact with tissue factor brings this on [20].…”

Section: Disseminated Intravascular Coagulationmentioning

confidence: 99%

Excess Body Mass—A Factor Leading to the Deterioration of COVID-19 and Its Complications—A Narrative Review

Gryczyńska

Litvinov

Bitew

et al. 2021

Viruses

View full text Add to dashboard Cite

Currently, the world is facing two serious pandemics: obesity and COVID-19. It is well-established that the prevalence of obesity has risen dramatically, causing a deterioration in the health quality of the population and increasing susceptibility for the unfavourable course of acute infections. It has been observed that excess body mass significantly influences the COVID-19 outcome. The aim of this review is to present the latest scientific reports on the impact of excess body mass on the course and complications of COVID-19. The Web of Science, PubMed, and Google Scholar databases were searched. Only studies reporting patients stated to be COVID-19 positive based on the results of a nasopharyngeal swab and the ribonucleic acid test were included. It is shown that thromboembolic and ischemic complications, namely stroke, disseminated intravascular coagulation, severe hyperglycaemia, and leukoencephalopathy are more likely to appear in COVID-19 positive patients with obesity compared to non-obese subjects. COVID-19 complications such as cardiomyopathy, dysrhythmias, endothelial dysfunction, acute kidney injury, dyslipidaemia, lung lesions and acute respiratory distress syndrome have a worse outcome among obese patients.

show abstract

Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies

Cited by 12 publications

References 32 publications

The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry

Excess Body Mass—A Factor Leading to the Deterioration of COVID-19 and Its Complications—A Narrative Review

Contact Info

Product

Resources

About