Risks and benefits of oral anticoagulants for stroke prophylaxis in atrial fibrillation according to body mass index: Nationwide cohort study of primary care records in England.
Risks and benefits of oral anticoagulants for stroke prophylaxis in atrial fibrillation according to body mass index: Nationwide cohort study of primary care records in England.
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DOI：
10.1016/j.eclinm.2022.101709
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发表时间：
2022-12
影响因子：
15.1
通讯作者：
Gale, Chris P.
中科院分区：
文献类型：
--
作者：
Nakao, Yoko M.;Nakao, Kazuhiro;Wu, Jianhua;Nadarajah, Ramesh;Camm, A. John;Gale, Chris P.
直接口服抗凝剂(DOAC)是预防房颤(AF)卒中的有效和安全的华法林替代品。目前尚不清楚这是否适用于身体质量指数(BMI)达到极端的患者。使用关联的主要和次要数据，从2010年1月1日到2018年11月30日，我们纳入了服用口服抗凝剂(OAC)的房颤患者的CHA2DS2-VASC评分≥3和男性≥2。结果是缺血性中风、大出血和世界卫生组织BMI分类的全因死亡。接受华法林治疗的患者与接受DOAC治疗的患者的倾向得分匹配(1：1比率)，并使用COX比例风险模型量化时变OAC暴露与预后的关系。包括29,135例(22,818例华法林，6317例DOAC)，585例(2.0%)体重不足，8427例(28.9%)正常体重，10,705例(36.7%)超重，5910例(20.3%)I级肥胖，3508例(12.0%)II/III级肥胖。接受DOAC治疗的患者年龄更大，合并疾病也更多。经过3.7(SD 2.5)年的随访，DOAC组和华法林组在缺血性卒中和大出血风险方面没有差别。正常体重、超重和肥胖的I级患者使用DOAC治疗时，全因死亡的风险高于华法林(HR：1.45[95%CI1.24-1.69]，P<0.001；1.41[95%CI1.19-1.66]，P<0.001；1.90[95%CI1.50-2.39]，P<0.001)，在DOAC成为最常见的OAC处方后没有观察到这种影响。在体重不足的患者中，接触OAC与出血的危害比从中风预防中受益更大(益处/危害比，0.35[95%CI 0.26-0.44])。在每种BMI分类的房颤患者中，我们发现与华法林相比，DOAC在缺血性卒中和出血风险方面没有差异。与其他BMI类型相比，体重不足的患者从口服抗凝中经历了不同的风险-收益模式。没有。
Direct oral anticoagulants (DOACs) are effective and safe alternatives to warfarin for stroke prophylaxis for atrial fibrillation (AF). Whether this extends to patients at the extremes of body mass index (BMI) is unclear. Using linked primary and secondary data, Jan 1, 2010 to Nov 30, 2018, we included CHA2DS2-VASC score ≥3 in women and ≥2 in men with AF treated with oral anticoagulants (OACs). Outcomes were ischaemic stroke, major bleeding and all-cause mortality by World Health Organisation BMI classification. Patients who received warfarin were propensity score matched (1:1 ratio) with those who received DOACs and the association of time-varying OAC exposure on outcomes quantified using Cox proportional hazards models. We included 29,135 (22,818 warfarin, 6317 DOAC); 585 (2.0%) underweight, 8427 (28.9%) normal weight, 10,705 (36.7%) overweight, 5910 (20.3%) class I obesity and 3508 (12.0%) class II/III obesity. Patients treated with DOACs were older and more comorbid. After 3.7 (SD 2.5) years follow up, there was no difference in risk of ischaemic stroke and major bleeding by BMI category between DOACs and warfarin. Normal weight, overweight and obese class I patients had higher risk of all-cause mortality when treated with DOACs compared with warfarin (HR: 1.45 [95% CI 1.24–1.69], p < 0.001; 1.41 [95% CI 1.19–1.66], p < 0.001; and 1.90 [95% CI 1.50–2.39], p < 0.001), an effect not observed after DOACs became the most common OAC prescription. Amongst underweight patients OAC exposure was associated with greater harm from bleeding than benefit from stroke prevention (benefit to harm ratio, 0.35 [95% CI 0.26–0.44]). In patients with AF in each BMI classification we found no difference in ischaemic stroke and bleeding risk for DOACs compared with warfarin. Underweight patients experienced divergent risk-benefit patterns from oral anticoagulation compared with other BMI categories. None.
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影响因子：
39.3
作者：
Camm AJ;Amarenco P;Haas S;Hess S;Kirchhof P;Kuhls S;van Eickels M;Turpie AG;XANTUS Investigators
通讯作者：
XANTUS Investigators
DOI：
10.1093/ehjcvp/pvz071
发表时间：
2021-01-16
期刊：
European heart journal. Cardiovascular pharmacotherapy
影响因子：
--
作者：
Harris DE;Thayer D;Wang T;Brooks C;Murley G;Gravenor M;Hill NR;Lister S;Halcox J
通讯作者：
Halcox J
影响因子：
3.9
作者：
Deitelzweig, Steve;Keshishian, Allison;Lip, Gregory Y. H.
通讯作者：
Lip, Gregory Y. H.
影响因子：
2.3
作者：
Costa, Olivia S.;Beyer-Westendorf, Jan;Coleman, Craig, I
通讯作者：
Coleman, Craig, I
影响因子：
168.9
作者：
Ruff, Christian T.;Giugliano, Robert P.;Antman, Elliott M.
通讯作者：
Antman, Elliott M.