Comparing DOAC and warfarin outcomes in an obese population using the 'real-world' Michigan Anticoagulation Quality Improvement Initiative (MAQI

Direct oral anticoagulants (DOACs) have overtaken warfarin in the treatment of nonvalvular atrial fibrillation (AF) and venous thromboembolism (VTE). Limited data explore the safety of DOACs in obesity. This multicenter retrospective study between June 2015 and September 2019 uses the Michigan Anticoagulation Quality Improvement Initiative (MAQI DOACs were prescribed to 49% of the 4089 patients with AF and 46% of the 3162 patients with VTE. Compared to patients treated with warfarin, those treated with DOACs had a higher estimated glomerular filtration rate across BMI categories regardless of indication. In the AF population, severely obese patients treated with DOACs had more major (3.4 vs 1.8, There is a higher rate of bleeding in severely obese patients with VTE and AF treated with DOACs compared to warfarin, without a difference in secondary outcomes. Further studies to compare the anticoagulant classes and understand bleeding drivers in this population are needed.

Déclaration de conflit d'intérêts

Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Geoffery Barnes reports research funding from Boston Scientific; consulting for Pfizer, Bristol-Myers Squibb (BMS), Janssen, Bayer, AstraZeneca, Sanofi, Anthos, Abbott Vascular, and Boston Scientific; and he serves on the Board of Directors for the Anticoagulation (AC) Forum. Dr Scott Kaatz reports research funding from Janssen, BMS, Osmosis Research, National Institutes of Health, and Bayer; consulting for Janssen, Pfizer, BMS, AstraZeneca, Gilead, Phase Bio, Boston Scientific, Inari, and Anthos; and Board membership for AC Forum, National Blood Clot Alliance Medical and Scientific Advisory Board, and PERT Consortium. Dr James Froelich reports research funding from Blue Cross Blue Shield of Michigan and FMD Society of America. The remaining authors have no conflicts of interest.