Safety and efficacy of direct oral anticoagulants in comparison with warfarin across different BMI ranges: A systematic review and meta-analysis.
Ann Med Surg (Lond)
; 77: 103610, 2022 May.
Article
en En
| MEDLINE
| ID: mdl-35637978
ABSTRACT
Background:
Many publications have compared various outcomes defining safety and efficacy of DOACs across different BMI ranges. Our meta-analysis compares warfarin and DOACs for its treatment effects over different BMI ranges.Methods:
A systematic search was conducted from inception to May 2021 on PubMed, Scopus and Embase databases. The data was extracted and pooled using a random effects model. Our study consisted of patients being treated for VTE and AF, across different BMI categories. For the comparison of DOAC, risk ratios (RR) with 95% confidence intervals (CIs) were used, whilst for the second comparison between warfarin and DOACs odds ratios (OR) were used.Results:
In our first comparison, 12 studies (n = 254,908 patients) were included. For our second comparison, six studies (n = 109,609 patients) were included. Major bleeding events in the underweight group were higher than normal weight [RR 1.89 (1.10, 3.23); P = 0.02; I 2 = 0%]. Overweight patients were related with reduced rates of VTE than in patients with normal BMI [RR 0.86 (0.76, 0.97); P = 0.02; I 2 = 0%]. In comparison with patients receiving warfarin, DOACs had significantly reduced risk of major bleeding in normal weight, overweight and obese [OR 0.64 (0.49, 0.83); P = 0.0007 I 2 = 90%].Conclusion:
The risk of VTE reduces with an increasing BMI, hence there could be a possible obesity paradox in patients with anticoagulation therapy. In comparison to warfarin, DOACs proved to be the safer option by having a reduced risk of bleeding across all BMI categories.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Tipo de estudio:
Systematic_reviews
Idioma:
En
Revista:
Ann Med Surg (Lond)
Año:
2022
Tipo del documento:
Article
País de afiliación:
Irlanda