Karatisidis, Lazaros, Zagoridis, Konstantinos, Mprotsis, Theodoros, Misidou, Christina, Pentidou, Aikaterini, Vrachiolias, George, Bezirgianidou, Zoi, Kontomanolis, Emmanouil, and Spanoudakis, Emmanouil
Recommendations about proper anticoagulation in obese patients, body mass index (BMI) > 30 kg/m2, are not yet clearly defined. Obese patients were included in randomized controlled trials comparing new anticoagulants (NOACs) with warfarin in patients with atrial fibrillation or thromboembolism. We performed a medline search entering proper criteria and finally 6 post-hoc analysis of RCTs, reporting outcome according to BMI, were included in this meta-analysis. Two major outcomes were considered end points in our meta-analysis; thrombosis, including ischemic cerebral events (transient or not) and venous thrombosis (DVD) /pulmonary embolism (PE) and bleeding, including major bleeding and clinically relevant non-major bleeding. In the NOACs treated group, thrombosis occurred less frequently in obese vs non-obese patients; RR and 95 % CI 0,75 (0,58–0,97), p = 0,03, while low heterogeneity was observed (I2= 40 %). In the warfarin treated subgroup there was statistically significant difference with less thrombotic events occurring in the obese vs non-obese patients; RR and (95 % CI) 0,80 (0,66-0,98), p = 0,03, and heterogeneity was low (I2 = 24 %). This protective effect called the obesity paradox is limited to obese patients anticoagulated for non-valvular atrial fibrillation (NVAF); RR (95 % CI) was 0,70 (0,58–0,85) p = 0,03 and I2 = 24 %. Bleeding events were similar under both NOACs and warfarin in obese vs non-obese analysis. Obese patients anticoagulated for NVAF with either standard dose of xabans or INR guided warfarin are more efficiently protected against thrombosis compared to non-obese patients. • Proper anticoagulation therapy in obese patients is a matter of debate. • We extracted data from 6 randomized controlled trials and we performed a paired obese vs non-obese and xabans vs warfarin meta-analysis including patients treated for either Atrial Fibrillation or Venous Thromboembolism. • In the Novel Oral Anticoagulants treated group thrombosis occurred less frequently in obese vs non-obese patients; Risk Ratio and 95% Confidence Interval was 0,75 (0,58-0,97), p = 0,03. • In the warfarin treated subgroup less thrombotic events occurred in obese vs non-obese patients; Risk Ratio and 95% Confidence Interval was 0,80 (0,66-0,98), p =0,03. • Bleeding events are not statistically different in obese vs non obese patients under both anticoagulants. [ABSTRACT FROM AUTHOR]