用 Xa 因子抑制剂治疗严重肥胖患者的心房颤动和静脉血栓栓塞。

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2024-12-01 DOI:10.1016/j.jtha.2024.08.009

Paul Dobry , Stephanie B. Edwin , Brian Haymart , Geoffrey D. Barnes , Scott Kaatz , Mona A. Ali , Christopher Giuliano

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引用次数: 0

摘要

背景：在体重≥150公斤或体重指数≥50公斤/平方米的重度肥胖患者中，支持使用Xa因子抑制剂的数据很少：本研究旨在评估Xa因子抑制剂在治疗体重≥50 kg/m2和/或体重≥150 kg的心房颤动（AF）和/或静脉血栓栓塞（VTE）时是否与华法林一样安全有效：这是一项多中心回顾性队列研究，研究对象是接受 Xa 因子抑制剂或华法林治疗的房颤和/或 VTE 重度肥胖成年患者。主要有效性结局是中风、全身性栓塞或 VTE 的复合几率；主要安全性结局是大出血的几率。次要结局包括中风或全身性栓塞、VTE、大出血、临床相关的非大出血、全因死亡率、抗凝剂量变化和住院总次数。在开始服用研究药物后的 12 个月内对结果进行评估：共纳入了 1,736 名患者。总体组群的平均体重和体重指数分别为 164.4 千克和 54.6 千克/平方米。各组间发生中风、全身性栓塞或 VTE（OR 1.005，95% CI 0.6 - 1.68）或大出血（OR 0.9，95% CI 0.47 - 1.7）的几率没有差异：这些数据表明，对于体重指数≥50 kg/m2和/或体重≥150 kg的患者，阿哌沙班和利伐沙班是华法林治疗房颤和/或VTE的安全有效的替代药物。

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Treatment of atrial fibrillation and venous thromboembolism with factor Xa inhibitors in severely obese patients

Background

A paucity of data exists to support the use of factor (F)Xa inhibitors in severely obese patients with a weight of ≥150 kg or body mass index (BMI) of ≥50 kg/m².

Objectives

The purpose of this study was to evaluate whether FXa inhibitors are as safe and effective as warfarin for the treatment of atrial fibrillation (AF) and/or venous thromboembolism (VTE) in individuals with a BMI of ≥50 kg/m² and/or weight of ≥150 kg.

Methods

This was a multicenter retrospective cohort study of severely obese adult patients with AF and/or VTE treated with a FXa inhibitor or warfarin. The primary effectiveness outcome was composite odds of stroke, systemic embolism, or VTE; the primary safety outcome was odds of major bleeding. Secondary outcomes included incidence of stroke or systemic embolism, VTE, major bleeding, clinically relevant nonmajor bleeding, all-cause mortality, change in anticoagulation, and total number of hospital encounters. Outcomes were assessed for 12 months following initiation of study drug.

Results

A total of 1736 patients were included. The mean weight and BMI of the overall cohort were 164.4 kg and 54.6 kg/m², respectively. There was no difference in odds of stroke, systemic embolism or VTE (odds ratio, 1.005; 95% CI, 0.6-1.68), or major bleeding (odds ratio, 0.9; 95% CI, 0.47-1.7) between groups.

Conclusion

These data suggest that apixaban and rivaroxaban are safe and effective alternatives to warfarin for the treatment of AF and/or VTE in individuals with a BMI of ≥50 kg/m² and/or weight of ≥150 kg.

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.