Presentation Details
| Apixaban and Rivaroxaban Versus Warfarin as Atrial Fibrillation or Venous Thromboembolism Treatment in Severely Obese Patients: A Multicenter Retrospective Analysis Paul Dobry1, 2, Stephanie Edwin1, Susan Szpunar3, Christopher Giuliano1, 2. 1Department of Pharmacy, Ascension St.John Hospital, Detroit, MI, USA.2Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA.3Department of Medical Education, Ascension St.John Hospital, Detroit, MI, USA |
Abstract
Background: Factor Xa inhibitors such as apixaban and rivaroxaban have emerged as first line agents to treat both non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE). Obesity is an independent risk factor for both NVAF and VTE, and as the prevalence of obesity continues to rise, the need for data corroborating the safe and effective use of factor Xa inhibitors in this population persists. In particular, there are a paucity of data surrounding the use of factor Xa inhibitors in severely obese patients with a weight ≥ 150kg or BMI ≥ 50 kg/m2. Objectives: The purpose of this study is to evaluate whether factor Xa inhibitors are as safe and effective as warfarin for the treatment of NVAF and/or VTE in individuals with a BMI ≥ 50 kg/m2 and/or weight ≥ 150 kg. Methods: This was a multicenter retrospective cohort study of severely obese adult patients diagnosed with NVAF and/or VTE and treated with a factor Xa inhibitor (apixaban or rivaroxaban) or warfarin between January 1, 2012 and December 31, 2022. Patients were identified through two pre-existing databases collectively comprised of data from 7 different health systems. The primary efficacy outcome was odds of stroke / systemic embolism within 12 months and the primary safety outcome was odds of major bleeding within 12 months. Secondary outcomes included incidence of stroke / systemic embolism, major bleeding, VTE, clinically relevant non-major bleeding, all-cause mortality, change in anticoagulation and total number of hospital encounters. Results: A total of 1,736 patients were included in the final analysis; 1,073 in the warfarin group and 663 in the factor Xa inhibitor group (349 apixaban and 314 rivaroxaban). The mean weight and BMI of the overall cohort was 164.4 kg and 54.6 kg/m2, respectively. There was no difference in odds of stroke or systemic embolism (OR 0.79, 95% CI 0.37 - 1.67) or major bleeding (OR 0.9, 95% CI 0.47 - 1.7) with warfarin compared to factor Xa inhibitors after controlling for covariates. Similar results were observed in the propensity matched sensitivity analysis. Conclusions: This analysis of real-world data suggests that apixaban and rivaroxaban are safe and effective alternatives to warfarin for the treatment of NVAF and/or VTE in individuals with a BMI ≥ 50 kg/m2 and/or weight ≥ 150 kg.
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