Network Meta-Analysis Comparing Apixaban Versus Rivaroxaban in Morbidly Obese Patients With Atrial Fibrillation

2020 ◽  
Vol 134 ◽  
pp. 160-161
Author(s):  
Kazuhiko Kido ◽  
Mikiko Shimizu ◽  
Tsuyoshi Shiga ◽  
Masayuki Hashiguchi
Keyword(s):  
Atrial Fibrillation ◽  
Meta Analysis ◽  
Morbidly Obese ◽  
Obese Patients

Efficacy and safety of direct oral anticoagulant in morbidly obese patients with atrial fibrillation: systematic review and meta-analysis

2021 ◽  
Author(s):  
Sittinun Thangjui ◽  
Jakrin Kewcharoen ◽  
Ratdanai Yodsuwan ◽  
Angkawipa Trongtorsak ◽  
Harshith Thyagaturu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Lower Risk ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Direct Oral Anticoagulant ◽  
Efficacy And Safety

Abstract Aims  We conducted a systematic review and meta-analysis on three outcomes. We assessed the efficacy and safety of direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) in morbidly obese patients with atrial fibrillation (AF). We compared the efficacy and safety of DOAC in obese patients and non-obese patients with AF. Finally, we updated the current knowledge of outcomes of AF patients with obesity compared with normal-weight patients regardless of anticoagulation type. Methods and results  Using PubMed and Embase, we searched for literature published from inception to August 2020 for studies conducted in morbidly obese patients with AF who used DOACs and/or VKA for stroke or systemic embolism (stroke/SE) prevention that report efficacy and/or safety data. GRADE assessment was performed to determine the quality of the meta-analysis results. Direct oral anticoagulant was not statistically different from VKA in reducing stroke/SE with relative risk (RR) of 0.85 [95% confidence interval (CI): 0.56–1.29; very low certainty evidence]. Major bleeding risk was lower in the DOAC groups with RR of 0.62 (95% CI: 0.48–0.80; low certainty evidence). Obese patients with AF who used DOACs had lower risk of stroke/SE and similar major bleeding risk compared to non-obese patients with RR of 0.77 (95% CI: 0.70–0.84; low certainty evidence) and 1.02 (95% CI: 0.94–1.09; low certainty evidence), respectively. Obese patients with AF who used any type of anticoagulant had lower risk of stroke/SE compared to normal-weight patients with RR of 0.62 (95% CI: 0.57–0.69; low certainty evidence). Conclusion  The use of DOACs in morbidly obese patients may be reasonable if needed, and more dedicated studies are needed to make a more robust recommendation.

scholarly journals Safety and Efficacy of Direct Oral Anticoagulants in Morbidly Obese Patients: A Meta-Analysis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1166-1166
Author(s):  
Talha Aijaz ◽  
Okechukwu Nwabueze Obi ◽  
Nida Khokhar ◽  
Prasanth Lingamaneni ◽  
Muhammad Zain Farooq
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Observational Studies ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Efficacy And Safety ◽  
Randomized Control

Background: Direct oral anticoagulants (DOACS) were recently approved for anticoagulation in patients with atrial fibrillation for prevention of stroke and patient with venous thromboembolism (VTE) for the prevention of recurrent VTE. They have shown comparable efficacy and safety compared to vitamin K antagonist (VKA). DOACS have uniform pharmacokinetics and pharmacodynamics; hence, regular monitoring is not required. The morbidly obese patients may have increased volume of distribution and altered clearance which may alter the pharmacokinetics and consequently efficacy and safety of DOACS in these patients. 2016 International Society of Thrombosis and Hemostasis guideline recommends avoiding DOACS in a patient with body mass index (BMI) >40 kg/m2 or with body weight >120 kg due to lack of clinical trials. There is no sizeable randomized control trial to study the outcome of DOACS in morbidly obese patients, but subgroup analysis of a major randomized control trials and observational studies may provide the data on the efficacy and safety of DOACS. We intend to utilize this data in this meta-analysis to study the effectiveness and safety of DOACS in morbidly obese patients. Methods: Eligibility Criteria- Randomized control trial, observational studies including patients above 18 years with BMI>40kg/m2, body weight>120 kg and history of atrial fibrillation or VTE who are taking DOACS or warfarin for therapeutic purpose were included in the analysis. Study Selection- We searched Medline and Cochrane database. 52 studies were identified and 43 remained after removing duplicates. After assessing full text for eligibility 5 studies were included in the meta-analysis. Statistical analysis- Statistical analysis was performed with Review manager 5.3 by the Cochrane Collaboration. Forest plot was used to analyze publication bias. Heterogeneity in the studies were analyzed with Cochran Q analysis and I2 statistics. Results: Population characteristics were available in four studies. The mean age of the population ranged from 61.7 to 66.8 years, and mean BMI ranged from 44.8 to 46.7 kg/m2 . I2 analysis showed that the studies included were homogeneous, so fixed-effect model was applied. The incidence of recurrent VTE, stroke, or death ranged from 1.5% to 7.3% in DOACS compared to 1.2% to 7.9% in warfarin except in one study by Kalani et al. where it was 26% in DOACS vs. 20% in warfarin. Relative risk was 0.96 (confidence interval 0.75 - 1.28, p 0.78) indicating there was no significant difference in the primary efficacy outcome between the two groups. The incidence of major bleeding ranged from 1.5% to 4.8% in DOACS compared to 2.6% to 6.1% in warfarin. Relative risk was 0.72 (confidence interval 0.56 - 0.93, p 0.01) indicating that the risk of major bleeding was low among patient using DOACS. Conclusion: Efficacy of DOACS is similar compared to VKA when used for prevention of recurrence in VTE or prevention of stroke in atrial fibrillation in the patients with BMI>40 kg/m2 or bodyweight >120 kg. There was a trend towards a lower risk of bleeding in the patients with DOACS which is similar to the risk of major bleeding reported in non-obese patients in landmark randomized clinical trials. Only two studies included the patients with VTE, and additional studies are required to assess the safety and efficacy of DOACS among morbidly obese individuals with VTE. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Efficacy and safety of direct oral anticoagulants in morbidly obese patients with non-valvular atrial fibrillation: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Mhanna ◽  
A Beran ◽  
A Al-Abdouh ◽  
O Srour ◽  
W Abdulsattar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Efficacy And Safety ◽  
Systemic Embolism ◽  
Warfarin Group

Abstract Introduction Atrial fibrillation (AF) is the most common arrhythmia, with an estimated prevalence between 1–4%. On the other hand, obesity continued to be a prevalent health issue worldwide. Direct oral anticoagulants (DOACs) have been increasingly preferred over warfarin; however, The International Society of Thrombosis and Hemostasis (ISTH) recommended avoiding the use of DOACs in patients with a BMI >40 or weight >120 kg because of limited clinical data in these patients. In this meta-analysis, we aimed to evaluate the efficacy and safety of DOACs in morbidly obese patients with non-valvular AF. Method We performed a comprehensive literature search using multiple databases from database inception through January 2021, for all the studies that evaluated the efficacy and safety of DOACs in morbidly obese patients with non-valvular AF. The primary outcome of interest was stroke or systemic embolism (SSE) rate. The secondary outcome was major bleeding (MB). All meta-analyses were conducted using a random-effect model. Results A total of 10 studies including 89,494 morbidly obese patients (BMI >40 or weight >120 kg) with non-valvular AF on oral anticoagulation therapy (45427 on DOACs vs. 44067 on warfarin) were included in the final analysis. One included study was a randomized controlled trial (RCT), another study was a post hoc analysis of an RCT and the rest were retrospective cohort studies. The mean follow-up period was 1.8 years (range 8 months to 3.1 years). The SSE rate was significantly lower in DOACs group compared to warfarin group (odds ratio (OR): 0.71; 95% confidence interval (CI): 0.62, 0.81; p<0.0001; I2=0%). MB rate was also significantly lower in DOACs group compared to the warfarin group (OR 0.60, 95% CI 0.46–0.78, P<0.0001, I2=86%). Subgroup analysis in the rivaroxaban and apixaban AF cohort showed a statistically significant difference in SSE and MB event rates favoring both over warfarin therapy. Dabigatran showed non-inferiority to warfarin in SSE rate but superiority in the safety outcome. Conclusions Our meta-analysis demonstrated that DOACs are effective and safe when compared to warfarin in morbidly obese patients. However, more large scale randomized clinical trials are needed to further evaluate the efficacy and safety of DOACs compared to warfarin in this cohort of patients. FUNDunding Acknowledgement Type of funding sources: None. Stroke and systemic embolism events Major bleeding events

scholarly journals The Effect of Anesthesia and Analgesia on Control of Breathing after Bariatric Surgery: A Systematic Review and Meta-Analysis of Randomized Control Trials

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A I Ibrahim ◽  
H M Farag ◽  
M M Labib
Keyword(s):  
Bariatric Surgery ◽  
General Anesthesia ◽  
Meta Analysis ◽  
Control Of Breathing ◽  
Systemic Review ◽  
Common Finding ◽  
Morbidly Obese ◽  
Cochrane Central Register ◽  
Obese Patients ◽  
Management Of Complications

Abstract Background general anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and results in decreased oxygenation in the post anesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the pre anesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults. Aim of the Work: Study of the effect of anesthesia and analgesia on control of breathing after bariatric surgery. Patients and Methods study design: Systemic Review and Meta-analysis study. Published studies and abstracts concerning prevention and management of complications associated with patient positioning during surgeries were identified through a comprehensive search of electronic databases that will include PubMed (www.ncbi.nlm.nih.gov./entrez/query.fcgi), ScienceDirect (www.sciencedirect.com), Scirus (www.scirus.com/srsapp), ISI Web of Knowledge (http://www.isiwebofknowledge.com), Google Scholar (http://scholar.google. com) and CENTRAL (Cochrane Central Register of Controlled Trials (http://www. mrw.interscience.wiley.com/cochrane/cochrane_clcentral_articles_fs.htm), using a combination of the following key words: “Anesthesia”, “analgesia”, “respiratory outcome” and “morbid obese”. Results our initial search yielded 98 citations. Based on the screening criteria for titles and abstracts, 47 citations were excluded. After reviewing the full text of the remaining 52 reports, only 17 eligible RCTs fit our inclusion criteria and were selected for the study. All studies were published in English during 2000 to 2017, and the sample sizes ranged from 28 to 90 patients. Among these studies 50 obese patients were elevated and reported distinct outcome measurements. In all trials, the recruited patients were American Society of Anesthesiologists (ASA) status I–III who underwent general anesthesia with endotracheal intubation. In addition, in all trials the patients underwent elective bariatric operations. The mean BMI of the patients ranged from 37.7 to 54.0 kg/m2. Conclusion our meta-analysis indicated that recovery was significantly faster in the desflurane groups than in the sevoflurane, isoflurane, and propofol groups in obese adult patients who underwent bariatric surgery. Although no clinically relevant difference was observed in the PACU discharge time, or postoperative pain scores, patients who were given desflurane exhibited higher oxygen saturation on entry to or during stays in the PACU. Thus, in morbidly obese patients, we suggest that desflurane should be considered as the inhaled anesthetic because of its more rapid and consistent recovery profile.

scholarly journals Poor glycemic control in diabetic patients increases the risk of recurrent atrial arrhythmia and cardiovascular hospitalizations among morbidly obese patients undergoing atrial fibrillation ablation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K.M Stout ◽  
H Tandon ◽  
R Adomako ◽  
J.W Schleifer ◽  
J Payne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Primary Outcome ◽  
Morbidly Obese ◽  
Modifiable Risk Factors ◽  
Atrial Arrhythmias ◽  
Obese Patients ◽  
Lifestyle Modifications ◽  
Af Ablation ◽  
Excessive Alcohol

Abstract Background/Introduction Obesity and atrial fibrillation (AF) coexist and share multiple cardiovascular risk factors. Lifestyle modifications can reduce AF burden in obese patients. However, the time invested in pursing lifestyle changes may delay AF ablation, which could negate the procedural benefit. Purpose To examine the effects of lifestyle modifications and the timing of catheter ablation on morbidly obese patients with AF. Methods This retrospective study included 217 consecutive AF patients with a body mass index (BMI) ≥35 kg/m2 undergoing AF ablation at a tertiary care center from 2012 to 2019. Modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation of BMI >5% or an increase in BMI >3% prior to ablation, mean systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) ≥6.5%. The primary outcome was a composite of recurrent atrial arrhythmias and cardiovascular (CV) hospitalizations following AF ablation. A multivariate analysis adjusting for age, gender and modifiable risks was performed. Results The mean age was 61±9 years old, 58% were female and 45% had persistent AF. A substantial portion of the study patients had modifiable risk factors, ranging from 2.7% with excessive alcohol use to 67.3% experiencing delayed AF ablation, Figure 1. The median time from diagnosed AF to ablation was 1.3 years. During a mean follow-up of 2.9 years after AF ablation, 136 (62.7%) patients met the primary outcome. Only HbA1c ≥6.5% was an independent risk factor with adjusted hazard ratio of 1.57, 95% confidence interval 1.02–2.36, P=0.0412, Figure 2A. Delayed AF ablation did not alter the outcome, Figure 2B. There was no interaction between time of ablation and HbA1c ≥6.5% (P=0.67). Conclusion Substantial portions of morbidly obese patients undergoing AF ablation have potentially modifiable risk factors. Poor glycemic control with HbA1c ≥6.5% predicts an increased risk of recurrent atrial arrhythmias and CV hospitalizations, while delayed AF ablation does not. This finding underscores an importance of optimizing HbA1c in morbidly obese patients with AF to reduce adverse outcomes after ablation. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Risk of Atrial Fibrillation and Stroke After Bariatric Surgery in Patients With Morbid Obesity With or Without Obstructive Sleep Apnea

Stroke ◽  
2021 ◽  
Author(s):  
Ahmed Dalmar ◽  
Maharaj Singh ◽  
Zoe Heis ◽  
Tabitha L. Cumpian ◽  
Cheryl Ceretto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Weight Loss ◽  
Gastric Banding ◽  
Laparoscopic Adjustable Gastric Banding ◽  
Adjustable Gastric Banding ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
New Onset

Background and Purpose: Weight loss in morbidly obese patients reduces atrial fibrillation (AF); however, it is unknown whether similar benefits are maintained in patients with obstructive sleep apnea (OSA). We sought to determine whether incident AF and stroke rates are affected by OSA after weight loss and to identify predictors of AF and stroke. Methods: Differences in laparoscopic adjustable gastric banding–induced weight loss on incident AF and stroke events in those with and without OSA in the entire and in propensity-matched cohorts were determined longitudinally, and independent predictors of AF and stroke were identified. Results: Of 827 morbidly obese patients who underwent laparoscopic adjustable gastric banding (mean age, 44±11 years; mean body mass index, 49±8 kg/m 2 ), incident AF was documented in 4.96% and stroke in 5.44% of patients during a mean 6.0±3.2-year follow-up. Despite a similar reduction in body weight (19.6% and 21% in 3 years), new-onset AF was significantly higher in patients with OSA than without OSA in the entire (1.7% versus 0.5% per year; P <0.001) and propensity-matched cohorts. Incident stroke was higher in the OSA than in the non-OSA group (2.10% versus 0.47% per year; P <0.001), but only 20% of patients with stroke had documented AF. On multivariate analysis, OSA (hazard ratio, 2.88 [95% CI, 1.45–5.73]), age, and hypertension were independent predictors of new-onset AF, and OSA (hazard ratio, 5.84 [95% CI, 3.02–11.30]), depression, and body mass index were for stroke events. Conclusions: In morbidly obese patients who underwent laparoscopic adjustable gastric banding, despite similar weight loss, patients with OSA had a higher incidence of AF and stroke than patients without OSA. Both non-AF and AF-related factors were involved in increasing stroke risk. Further investigation is warranted into whether OSA treatment helps reduce AF or stroke events in this population.

scholarly journals Comparative effectiveness, safety, and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation

2019 ◽  
Vol 212 ◽  
pp. 113-119 ◽  
Author(s):  
Eric D. Peterson ◽  
Veronica Ashton ◽  
Yen-Wen Chen ◽  
Bingcao Wu ◽  
Alex C. Spyropoulos
Keyword(s):  
Atrial Fibrillation ◽  
Comparative Effectiveness ◽  
Morbidly Obese ◽  
Obese Patients
Sign in / Sign up

Export Citation Format

Share Document