Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review

Introduction: Data on optimal dosing of unfractionated heparin (UFH) in the presence of a direct oral anticoagulant (DOAC) to achieve and maintain an activated clotting time (ACT) of ≥300 seconds during catheter ablation of atrial fibrillation (CA-AF) are limited and prevalence of obesity adds to the unpredictable response to UFH. Methods and Results: One hundred seventeen consecutive patients undergoing CA-AF were prospectively administered weight-adjusted, weight-based UFH using a pre-specified detailed protocol and retrospectively analyzed. Due to lack of distribution of UFH into muscle or adipose tissue and lower degree of vascularity in the latter compartment, each patient’s ideal and actual weights were used to determine the adjusted-weight for use in all UFH doses. A UFH bolus of 200 units/kg was administered intravenously followed by an infusion of 35 units/kg/hour. The mean age was 65 years, and 85 patients (72.6%) were male. The average body mass index (BMI) was 30 (range 18-50) kg/m2. After the initial UFH bolus dose, 99 patients (84.6%) achieved ACT ≥300 sec with a mean (± SD) of 380 ± 79 sec. The mean time to reach an ACT ≥300 in all patients was 14.6 ± 12.4 minutes. Among all measured ACT values, 423 (90.8%) were ≥300 seconds. These results were consistent within all BMI categories. There were no intraprocedural thrombotic or hemorrhagic complications. Two patients (1.7%) sustained groin vascular access site hematoma without subsequent intervention and 7 patients (6%) experienced minor oozing post-procedurally. Conclusions: Our comprehensive weight-adjusted, weight-based UFH protocol, during CA-AF in presence of a DOAC, rapidly achieved and maintained an effective ACT irrespective of BMI.

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Abstract P003: Effectiveness And Safety Of Direct Oral Anticoagulants Compared With Warfarin In Patients With Atrial Fibrillation Across Body Mass Index Categories

Circulation ◽

10.1161/circ.143.suppl_1.p003 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Yoshihiro Tanaka ◽

Sadiya Khan ◽

Rachel Kaplan ◽

Philip Greenland ◽

Rod S Passman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Intracranial Hemorrhage ◽

Propensity Scores ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Safety Outcome ◽

One Year

Background: Although direct oral anticoagulants (DOACs) are preferred for most patients needing anticoagulation for atrial fibrillation (AF), uncertainty remains in the effectiveness and safety of DOACs compared with warfarin in patients with obesity. Available data from large real-word cohorts are lacking. Purpose: To examine the effectiveness and safety of DOACs compared with warfarin in patients with obesity and AF. Methods: We conducted a retrospective cohort study at an integrated, multi-site healthcare system. We included patients with AF prescribed either a DOAC or warfarin with ≥ one year of follow-up between 2010-2017. The primary effectiveness outcome was ischemic stroke or systemic embolism (S/SE) and the primary safety outcome was incident intracranial hemorrhage (ICH). Using logistic regression, we calculated propensity scores (PS) of prescription for DOAC in each body mass index (BMI) category (<25 kg/m2, 25.0-29.9 kg/m2, 30.0 to 34.9 kg/m2, and BMI≥35.0 kg/m2) using the following covariates: age, sex, race, ethnicity, BMI, systolic blood pressure, and CHA 2 DS 2 -VASc score. We used inverse probability weighting (IPW) based on the PS and IPW-weighted hazard ratios with 95% confidence intervals were calculated by Cox proportional hazard model. Results: Of a total of 17,905 patients included, mean (standard deviation [SD]) age was 70 ± 12 years and mean (SD) BMI was 29.9 ± 6.7 kg/m 2 ; nearly half received a prescription for DOAC (42.7%) and 57.3% for warfarin. During median follow-up of 3.8 years (interquartile range: 2.2-6.0), a total of 159 stroke and 376 intracranial hemorrhage events were observed. Patients on DOACs had a similar or lower HRs for both S/SE and ICH events compared with warfarin across each BMI category (Figure). Conclusion: In this retrospective study, DOACs were as safe and effective compared with warfarin across BMI categories in patients with AF.

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Impact of a targeted volume increase nutrition guideline on growth and body mass index (BMI) in premature infants: A retrospective review

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.2204 ◽

2021 ◽

Author(s):

Stephanie S Philip ◽

Sarah E Davenport ◽

Javed Mannan ◽

Heather O White ◽

Austin F Lee ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Premature Infants ◽

Retrospective Review ◽

Volume Increase

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DIRECT ORAL ANTICOAGULANTS PRESCRIBING PRACTICES IN THE TREATMENT OF VTE AT A QUATERNARY CARE CENTER: A RETROSPECTIVE REVIEW

CHEST Journal ◽

10.1016/j.chest.2019.08.101 ◽

2019 ◽

Vol 156 (4) ◽

pp. A15

Author(s):

Samir Patel ◽

Sheldon Rao ◽

Briana DiSilvio ◽

Tariq Cheema ◽

Lauren Finoli

Keyword(s):

Retrospective Review ◽

Care Center ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Prescribing Practices

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Efficacy and Safety of Direct Oral Anticoagulants for Atrial Fibrillation Across Body Mass Index Categories

Journal of the American Heart Association ◽

10.1161/jaha.120.017383 ◽

2020 ◽

Vol 9 (24) ◽

Author(s):

Rachel M. Kaplan ◽

Yoshihiro Tanaka ◽

Rod S. Passman ◽

Michelle Fine ◽

Laura J. Rasmussen‐Torvik ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Intracranial Hemorrhage ◽

Oral Anticoagulants ◽

Efficacy And Safety ◽

Class 1 ◽

Direct Acting ◽

Direct Acting Oral Anticoagulants

Background Direct‐acting oral anticoagulants are now the preferred method of anticoagulation in patients with atrial fibrillation. Limited data on efficacy and safety of these fixed‐dose regimens are available in severe obesity where drug pharmacokinetics and pharmacodynamics may be altered. The objectives of this study were to evaluate efficacy and safety in patients with atrial fibrillation taking direct‐acting oral anticoagulants across body mass index (BMI) categories in a contemporary, real‐world population. Methods and Results We performed a retrospective study of patients with atrial fibrillation at an integrated multisite healthcare system. Patients receiving a direct‐acting oral anticoagulant prescription and ≥12 months of follow‐up between 2010 and 2017 were included. The primary efficacy and safety outcomes were ischemic stroke or systemic embolism and intracranial hemorrhage. We performed Cox proportional hazards modeling to compute hazard ratios (HRs) adjusted for CHA 2 DS 2 ‐VASc score to examine differences by excess BMI categories relative to normal BMI. Of 7642 patients, mean±SD age was 69±12 years with a median (interquartile range) follow‐up of 3.8 (2.2–6.0) years. Approximately 22% had class 1 obesity and 19% had class 2 or 3 obesity. Stroke risks were similar in patients with and without obesity (HR, 1.2; 95% CI, 0.5–2.9; and HR, 0.68; 95% CI, 0.23–2.0 for class 1 and class 2 or 3 obesity compared with normal BMI, respectively). Risk of intracranial hemorrhage was also similar in class 1 and class 2 or 3 obesity compared with normal BMI (HR, 0.64; 95% CI, 0.35–1.2; and HR, 0.66; 95% CI, 0.35–1.2, respectively). Conclusions Direct‐acting oral anticoagulants demonstrated similar efficacy and safety across all BMI categories, even at high weight values.

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Impact of rituximab on anthropometric indices among childhood steroid-dependent nephrotic syndromes

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318019 ◽

2020 ◽

pp. archdischild-2019-318019

Author(s):

Rajiv Sinha ◽

Sushmita Banerjee ◽

Anwesha Mukherjee ◽

Shakil Akhtar ◽

Subal Pradhan

Keyword(s):

Body Mass Index ◽

Short Stature ◽

Body Mass ◽

Retrospective Review ◽

Anthropometric Parameters ◽

Anthropometric Indices ◽

Steroid Dependent ◽

Sparing Effect ◽

Steroid Sparing

BackgroundThere is scarcity of data on impact of rituximab on anthropometrical parameters (weight, height and body mass index i.e. BMI SD score (SDS)) among children with steroid-dependent nephrotic syndromes (SDNS).MethodsMulticentre retrospective review.Results102 children with SDNS (male: 63%; n=64), median age 7 (IQR: 4.3–9.6) years, received a total of 217 rituximab infusions (total 110 cycles). At median follow-up of 2.1 (IQR: 1.3–2.8) years, 58 (57%) children were off steroids and a significant fall in steroid threshold for relapse was noted (median 0.6; IQR 0.4–0.9 to median 0.3; IQR 0.12 - 0.5 mg/kg/alternate day, p=0.005). Anthropometric parameters (BMI SDS: 0.92±1.8 to 0.25±1.47, p=0.003; weight SDS: 0.20±1.6 to −0.11±1.3, p=0.01; and height SDS: −0.93±1.88 to −0.45±1.54, p=0.04) as well as obesity (38% to 20%, p=0.003) and short stature (11% to 3%, p=0.02) improved. Results remained significant even when analysis was restricted to children ≤12 years (n=88), (BMI SDS: 0.97±1.98 to 0.25±1.5, p=0.001; weight SDS: 0.33±1.6 to 0.02±1.2, p=0.01; and height SDS: −0.67±1.84 to −0.186±1.42, p=0.001).ConclusionsUse of rituximab resulted in significant steroid sparing effect with an improvement in both growth and obesity parameters.

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