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

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A Correction to this article was published on 30 March 2023

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Abstract

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.

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Funding

This study was funded by Janssen Scientific Affairs. Janssen reviewed the study protocol and manuscript but was not involved in the data analysis or manuscript writing. KM is supported by K23HL157758. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Author notes

  1. Lisa Baumann Kreuziger and Rachel P. Rosovsky are co senior authors.

Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 1020, Chicago, IL, 60611, USA

    Karlyn A Martin

  2. Northwestern University Feinberg School of Medicine, Chicago, USA

    Nicola Lancki

  3. Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Celina Li & Rachel P. Rosovsky

  4. Penn State Hershey Medical Center, Hershey, PA, USA

    M. Elaine Eyster

  5. Washington University St. Louis School of Medicine, Saint Louis, MO, USA

    Kristen Sanfilippo

  6. Saint Louis Veterans Administration Medical Center, Saint Louis, MO, USA

    Kristen Sanfilippo

  7. Loyola University, Chicago, IL, USA

    Isabela A. Woller

  8. Department of Medicine, Intermountain Medical Center, Murray, UT, USA

    Scott C. Woller

  9. Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Scott C. Woller

  10. Blood Research Institute, Versiti, Milwaukee, WI, USA

    Lisa Baumann Kreuziger

  11. Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Lisa Baumann Kreuziger

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  1. Karlyn A Martin
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Correspondence to Karlyn A Martin.

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The following authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper: CL, MEE, KS, SW, IW, LBK. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: RPR received research grants to her institution from BMS and Janssen and is a consultant to BMS and Janssen. KAM received a research grant to her institution from Janssen Scientific Affairs.

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Martin, K.A., Lancki, N., Li, C. et al. DOAC compared with warfarin for VTE in patients with obesity: a retrospective cohort study conducted through the VENUS network. J Thromb Thrombolysis 55, 685–690 (2023). https://doi.org/10.1007/s11239-023-02774-1

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