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Published on: February 26, 2013
Characterization of Antithrombotic Regimens for Patients with Nonvalvular Atrial Fibrillation and Obesity Discharged
Stephanie O'Byrne1, Kirsten Tangedal2, Brandon Kennedy2
1, PharmD, ACPR, is with Pharmacy Services, Saskatchewan Health Authority, Regina, Saskatchewan.
Insights
Direct oral anticoagulants (DOACs) are widely used for obese patients with nonvalvular atrial fibrillation. However, warfarin remains an option for the heaviest individuals, though more research is needed.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Optimal anticoagulation strategies for nonvalvular atrial fibrillation (NVAF) in obese patients remain unclear.
- Observational studies provide limited guidance for this patient population.
Purpose of the Study:
- To characterize direct oral anticoagulant (DOAC) prescribing patterns in adult NVAF patients weighing over 120 kg.
- To evaluate the use of different anticoagulant regimens in severely obese NVAF patients.
Main Methods:
- Retrospective cohort study in Saskatchewan Health Authority - Regina Area.
- Included adult NVAF patients weighing >120 kg, discharged by a cardiologist (June 2019 - July 2021).
- Analyzed anticoagulant regimens (DOACs vs. warfarin) at discharge.
Main Results:
- 62 patients included (median weight 135 kg).
- DOACs prescribed to 92% of patients at discharge; warfarin to 8%.
- Warfarin group showed higher thromboembolism risk, but small sample size limited definitive conclusions.
Conclusions:
- Significant adoption of DOACs for NVAF patients >120 kg in the study region.
- Warfarin use persists for the highest weight categories.
- Further investigation is warranted to establish optimal anticoagulation for this high-risk group.
Background:
Despite data derived from observational studies, optimal anticoagulation strategies have yet to be established for patients with nonvalvular atrial fibrillation and obesity.
Objective:
To describe direct oral anticoagulant (DOAC) regimens prescribed for adult patients with nonvalvular atrial fibrillation who weighed more than 120 kg.
Methods:
This single-centre, retrospective cohort study, conducted in the Saskatchewan Health Authority - Regina Area, involved adult patients with body weight greater than 120 kg who had an indication for oral anticoagulation to treat nonvalvular atrial fibrillation and were discharged by a cardiologist between June 2019 and July 2021.
Results:
A total of 62 patients were included (median weight 135 kg). At discharge, DOACs were prescribed for 57 (92%) of the patients and warfarin for 5 (8%). In numeric terms, patients receiving warfarin were at higher risk of thromboembolism or thrombosis; however, the small sample size limited the ability to draw conclusions.
Conclusions:
Practice patterns in the Saskatchewan Health Authority - Regina Area indicated substantial use of DOACs for patients with body weight greater than 120 kg; however, for those with the highest weights, warfarin was still in use.
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