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Review
. 2022 Apr 14:77:103610.
doi: 10.1016/j.amsu.2022.103610. eCollection 2022 May.

Safety and efficacy of direct oral anticoagulants in comparison with warfarin across different BMI ranges: A systematic review and meta-analysis

Talal Almas  1 , Faeez Muhammad  2 , Laiba Siddiqui  2 , Batool Shafi  2 , Rabbia Gul  2 , Rafiya Altaf  2 , Zaeem Abbasi  2 , Ghulam Mustafa  2 , Arham Iqbal  2 , Amatul Rehman Durdana  2 , Maham Dilawar  2 , Adeena Musheer  2 , Kaneez Fatima  2
Affiliations
Review

Safety and efficacy of direct oral anticoagulants in comparison with warfarin across different BMI ranges: A systematic review and meta-analysis

Talal Almas et al. Ann Med Surg (Lond). .

Abstract

Background: Many publications have compared various outcomes defining safety and efficacy of DOACs across different BMI ranges. Our meta-analysis compares warfarin and DOACs for its treatment effects over different BMI ranges.

Methods: A systematic search was conducted from inception to May 2021 on PubMed, Scopus and Embase databases. The data was extracted and pooled using a random effects model. Our study consisted of patients being treated for VTE and AF, across different BMI categories. For the comparison of DOAC, risk ratios (RR) with 95% confidence intervals (CIs) were used, whilst for the second comparison between warfarin and DOACs odds ratios (OR) were used.

Results: In our first comparison, 12 studies (n = 254,908 patients) were included. For our second comparison, six studies (n = 109,609 patients) were included. Major bleeding events in the underweight group were higher than normal weight [RR: 1.89 (1.10, 3.23); P = 0.02; I 2 = 0%]. Overweight patients were related with reduced rates of VTE than in patients with normal BMI [RR: 0.86 (0.76, 0.97); P = 0.02; I 2 = 0%]. In comparison with patients receiving warfarin, DOACs had significantly reduced risk of major bleeding in normal weight, overweight and obese [OR: 0.64 (0.49, 0.83); P = 0.0007 I 2 = 90%].

Conclusion: The risk of VTE reduces with an increasing BMI, hence there could be a possible obesity paradox in patients with anticoagulation therapy. In comparison to warfarin, DOACs proved to be the safer option by having a reduced risk of bleeding across all BMI categories.

Keywords: BMI (Body mass index); DOAC (direct oral anticoagulants); Efficacy; Safety; Warfarin.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Major bleeding events in underweight patients on different DOACs.
Fig. 2
Fig. 2
Major bleeding events in overweight patients on different DOACs.
Fig. 3
Fig. 3
Major bleeding events in obese patients on different DOACs.
Fig. 4
Fig. 4
Major bleeding events in obese class I patients on different DOACs.
Fig. 5
Fig. 5
Major bleeding events in obese class II-III patients on different DOACs.
Fig. 6
Fig. 6
VTE recurrence/stroke in underweight patients on different DOACs.
Fig. 7
Fig. 7
VTE recurrence/stroke in overweight patients on different DOACs.
Fig. 8
Fig. 8
VTE recurence/stroke in obese patients on different DOACs.
Fig. 9
Fig. 9
VTE recurrence/stroke in obese class I patients on different DOACs.
Fig. 10
Fig. 10
VTE recurrence/stroke in obese class II-III patients on different DOACs.
Fig. 11
Fig. 11
Bleeding in DOAC or warfarin therapy.
Fig. 12
Fig. 12
VTE recurrence or stroke in DOAC or warfarin therapy.
See this image and copyright information in PMC

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