Courtney S Pilkerton, Megan Adelman, Emily Crocetti, Jun Xiang, Victoria Strick, Charles D Ponte, Shaylee Peckens, Benjamin P Jackson, Kylen Whipp, Amie M Ashcraft
{"title":"直接口服抗凝剂:肥胖人群静脉血栓栓塞复发的概率和出血风险。","authors":"Courtney S Pilkerton, Megan Adelman, Emily Crocetti, Jun Xiang, Victoria Strick, Charles D Ponte, Shaylee Peckens, Benjamin P Jackson, Kylen Whipp, Amie M Ashcraft","doi":"10.1177/10600280231212186","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Direct-acting oral anticoagulants (DOACs) have become the preferred drugs for managing venous thromboembolism (VTE). Despite their advantages over vitamin K antagonists such as warfarin, their use in obese patients remains controversial with many providers reluctant to switch patients managed on warfarin. Outcome research that opts to increase provider confidence when prescribing DOACs for patients with obesity will be invaluable.</p><p><strong>Objective: </strong>This investigation evaluated whether patients with a body mass index (BMI) 35 kg/m<sup>2</sup> or greater who were prescribed a DOAC had a higher risk for a recurrent VTE or bleed event relative to warfarin.</p><p><strong>Methods: </strong>The study was conducted in West Virginia which has the highest rate of obesity in the United States.</p><p><strong>Results: </strong>Of the total study population (1633), 2.3% (37) had a recurrent thrombotic event, 5.5% (89) had a major bleed event, and 10.7% (174) had some type of bleeding event. No individual patient characteristic was associated with recurrent thrombosis-including BMI. Older age, antiplatelet use, and taking a medication with a theoretical risk of increasing the effect of DOACs were associated with any and major bleeding events. The use of warfarin was associated with major bleeding events more frequently versus a DOAC. Body mass index was not a predictor for recurrent VTE or any bleed or major bleed events.</p><p><strong>Conclusions: </strong>These findings support the conclusion that DOACs are an appropriate and effective drug class for the management of VTE in patients with obesity.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"781-789"},"PeriodicalIF":2.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Direct Oral Anticoagulants: Probability of Recurrent Venous Thromboembolism and Bleeding Risk in an Obese Population.\",\"authors\":\"Courtney S Pilkerton, Megan Adelman, Emily Crocetti, Jun Xiang, Victoria Strick, Charles D Ponte, Shaylee Peckens, Benjamin P Jackson, Kylen Whipp, Amie M Ashcraft\",\"doi\":\"10.1177/10600280231212186\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Direct-acting oral anticoagulants (DOACs) have become the preferred drugs for managing venous thromboembolism (VTE). Despite their advantages over vitamin K antagonists such as warfarin, their use in obese patients remains controversial with many providers reluctant to switch patients managed on warfarin. Outcome research that opts to increase provider confidence when prescribing DOACs for patients with obesity will be invaluable.</p><p><strong>Objective: </strong>This investigation evaluated whether patients with a body mass index (BMI) 35 kg/m<sup>2</sup> or greater who were prescribed a DOAC had a higher risk for a recurrent VTE or bleed event relative to warfarin.</p><p><strong>Methods: </strong>The study was conducted in West Virginia which has the highest rate of obesity in the United States.</p><p><strong>Results: </strong>Of the total study population (1633), 2.3% (37) had a recurrent thrombotic event, 5.5% (89) had a major bleed event, and 10.7% (174) had some type of bleeding event. No individual patient characteristic was associated with recurrent thrombosis-including BMI. Older age, antiplatelet use, and taking a medication with a theoretical risk of increasing the effect of DOACs were associated with any and major bleeding events. The use of warfarin was associated with major bleeding events more frequently versus a DOAC. Body mass index was not a predictor for recurrent VTE or any bleed or major bleed events.</p><p><strong>Conclusions: </strong>These findings support the conclusion that DOACs are an appropriate and effective drug class for the management of VTE in patients with obesity.</p>\",\"PeriodicalId\":7933,\"journal\":{\"name\":\"Annals of Pharmacotherapy\",\"volume\":\" \",\"pages\":\"781-789\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Pharmacotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10600280231212186\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/11/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Pharmacotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10600280231212186","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/23 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
Direct Oral Anticoagulants: Probability of Recurrent Venous Thromboembolism and Bleeding Risk in an Obese Population.
Background: Direct-acting oral anticoagulants (DOACs) have become the preferred drugs for managing venous thromboembolism (VTE). Despite their advantages over vitamin K antagonists such as warfarin, their use in obese patients remains controversial with many providers reluctant to switch patients managed on warfarin. Outcome research that opts to increase provider confidence when prescribing DOACs for patients with obesity will be invaluable.
Objective: This investigation evaluated whether patients with a body mass index (BMI) 35 kg/m2 or greater who were prescribed a DOAC had a higher risk for a recurrent VTE or bleed event relative to warfarin.
Methods: The study was conducted in West Virginia which has the highest rate of obesity in the United States.
Results: Of the total study population (1633), 2.3% (37) had a recurrent thrombotic event, 5.5% (89) had a major bleed event, and 10.7% (174) had some type of bleeding event. No individual patient characteristic was associated with recurrent thrombosis-including BMI. Older age, antiplatelet use, and taking a medication with a theoretical risk of increasing the effect of DOACs were associated with any and major bleeding events. The use of warfarin was associated with major bleeding events more frequently versus a DOAC. Body mass index was not a predictor for recurrent VTE or any bleed or major bleed events.
Conclusions: These findings support the conclusion that DOACs are an appropriate and effective drug class for the management of VTE in patients with obesity.
期刊介绍:
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days