Abstract
Objectives Obesity is associated with increased risks of atrial fibrillation (AF) and venous
thromboembolism (VTE) for which anticoagulation is commonly used. However, data on
the efficacy and safety of oral anticoagulants in patients with morbid obesity are
limited.
Methods We conducted a systematic review and meta-analysis to evaluate the efficacy and safety
of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for AF or VTE
in patients with morbid obesity.
Results We included three randomized controlled trials (5 studies) and 18 observational studies
in adult patients with a body weight ≥120 kg, body mass index ≥40 kg/m2, or classified as morbid obesity who received DOACs or VKAs for AF or VTE (N = 77,687). The primary efficacy outcome was stroke/systemic embolism or recurrent
VTE, and the primary safety outcome was major bleeding. DOACs were associated with
a pooled incidence rate of stroke/systemic embolism of 1.16 per 100 person-years,
compared to 1.18 with VKAs. The incidence of recurrent VTE on DOACs was 3.83 per 100
person-years, compared to 6.81 on VKAs. In both VTE and AF populations, DOACs were
associated with lower risks of major bleeding compared to VKAs. However, all observational
studies had moderate to serious risks of bias.
Conclusion Patients with morbid obesity on DOACs had similar risks of stroke/systemic embolism,
lower rates of recurrent VTE, and major bleeding events compared to those on VKAs.
However, the certainty of evidence was low given that studies were mostly observational
with high risk of confounding.
Keywords
direct oral anticoagulants - vitamin K antagonists - atrial fibrillation - venous
thromboembolism - morbid obesity
