DOAC compared with warfarin for VTE in patients with obesity: a retrospective cohort study conducted through the VENUS network

The effectiveness and safety of direct oral anticoagulants (DOAC) compared with warfarin remains uncertain in obese patients. We assessed the comparative effectiveness and safety of DOACs with warfarin for the treatment of VTE among obese patients. This multi-center retrospective cohort study included adults with a BMI ≥ 35 kg/m2 or weight ≥ 120 kg prescribed either DOAC (apixaban, dabigatran, edoxaban, rivaroxaban) or warfarin for a VTE diagnosis. The primary outcome was the 12-month rate of recurrent VTE. The secondary outcome was the 12-month rate of major bleeding. Among 5626 patients, 67% were prescribed warfarin and 33% were prescribed a DOAC. The 12-month VTE recurrence rate was 3.6% (67/1823) for patients treated with DOAC compared with 3.8% (143/3664) for patients treated with warfarin [odds ratio for recurrent VTE on warfarin versus DOAC (OR) (95% CI).07 (0.80, 1.45)]. The 12-month major bleeding rate was 0.5% (10/1868) for patients on DOAC versus 2.4% (89/3758) on warfarin [OR 4.25 (2.19, 8.22)]. Similar proportions of recurrent VTE occurred across BMI thresholds on DOAC and warfarin: for BMI ≥ 35 kg/m2 (N = 5412), 3.6% versus 3.8%, respectively [OR 1.08 (0.80, 1.46)]; for BMI ≥ 40 kg/m2 (N = 2321), 4.4% versus 3.5%, respectively [OR 0.80 (0.51, 1.26)]; and for BMI ≥ 50 kg/m2 (N = 560), 3.1% versus 3.7%, respectively [OR 1.18 (0.39, 3.56)]. Similar proportions of recurrent VTE occurred in patients with obesity treated for VTE with DOACs and warfarin. DOACs were associated with lower major bleeding compared to warfarin in patients with obesity and VTE.

 

Comments：

This study compared the effectiveness and safety of direct oral anticoagulants (DOACs) with warfarin in treating venous thromboembolism (VTE) in obese patients. The study found that the 12-month rate of recurrent VTE was similar between the two groups, with a rate of 3.6% in patients treated with DOACs and 3.8% in patients treated with warfarin. However, the 12-month major bleeding rate was lower in patients treated with DOACs, with a rate of 0.5%, compared to 2.4% in patients treated with warfarin. The results were consistent across different levels of obesity, including BMI thresholds of 35, 40, and 50 kg/m2. In conclusion, the study found that DOACs were not inferior to warfarin in terms of VTE recurrence, and were associated with a lower major bleeding rate in obese patients with VTE.

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