Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis
Abstract Introduction Guidelines have endorsed non-vitamin K antagonist oral anticoagulants (NOACs), consisting of factor Xa inhibitors (xabans) and direct thrombin inhibitors, as the first line of treatment in venous thromboembolism (VTE) and atrial fibrillation. However, morbidly obese patients we...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-023-03067-4 |
| _version_ | 1797865603458924544 |
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| author | Dae Yong Park Seokyung An Abdul Wahab Arif Muhammad Khawar Sana Aviral Vij |
| author_facet | Dae Yong Park Seokyung An Abdul Wahab Arif Muhammad Khawar Sana Aviral Vij |
| author_sort | Dae Yong Park |
| collection | DOAJ |
| description | Abstract Introduction Guidelines have endorsed non-vitamin K antagonist oral anticoagulants (NOACs), consisting of factor Xa inhibitors (xabans) and direct thrombin inhibitors, as the first line of treatment in venous thromboembolism (VTE) and atrial fibrillation. However, morbidly obese patients were under-represented in landmark trials of NOACs. Therefore, this study aimed to systematically review and perform a meta-analysis of studies on xabans versus vitamin K antagonist (VKA) in this high-risk population with VTE. Methods PubMed, Embase, Medline, Cochrane library, and Google Scholar databases were searched to identify studies that compared xabans and VKA in treating morbidly obese patients with VTE. Morbid obesity was defined as body weight ≥ 120 kg or BMI ≥ 40 kg/m2. Outcomes of interest included recurrent VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB). Results Eight studies comprising 30,895 patients were included. A total of 12,755 patients received xabans while 18,140 received VKAs. No significant difference in the odds of recurrent VTE (OR 0.75, 95% CI 0.55–1.01) and CRNMB (OR 0.69, 95% CI 0.44–1.09) was observed between the xabans group and the VKA group. However, the xabans group was associated with lower odds of major bleeding (OR 0.70, 95% CI 0.59–0.83). Conclusion Xabans have lower odds of major bleeding but similar odds of recurrent VTE when compared with VKAs in treating VTE in morbidly obese patients. Large registry analyses or future randomized controlled trials will be helpful in confirming these findings. |
| first_indexed | 2024-04-09T23:11:54Z |
| format | Article |
| id | doaj.art-599dd3b9b33d43619ea52dad352f6075 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-04-09T23:11:54Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-599dd3b9b33d43619ea52dad352f60752023-03-22T10:22:36ZengBMCBMC Cardiovascular Disorders1471-22612023-02-012311910.1186/s12872-023-03067-4Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysisDae Yong Park0Seokyung An1Abdul Wahab Arif2Muhammad Khawar Sana3Aviral Vij4Department of Medicine, John H. Stroger Jr Hospital of Cook CountyDepartment of Biomedical Science, Seoul National University Graduate SchoolDepartment of Medicine, John H. Stroger Jr Hospital of Cook CountyDepartment of Medicine, John H. Stroger Jr Hospital of Cook CountyDivision of Cardiology, Cook County HealthAbstract Introduction Guidelines have endorsed non-vitamin K antagonist oral anticoagulants (NOACs), consisting of factor Xa inhibitors (xabans) and direct thrombin inhibitors, as the first line of treatment in venous thromboembolism (VTE) and atrial fibrillation. However, morbidly obese patients were under-represented in landmark trials of NOACs. Therefore, this study aimed to systematically review and perform a meta-analysis of studies on xabans versus vitamin K antagonist (VKA) in this high-risk population with VTE. Methods PubMed, Embase, Medline, Cochrane library, and Google Scholar databases were searched to identify studies that compared xabans and VKA in treating morbidly obese patients with VTE. Morbid obesity was defined as body weight ≥ 120 kg or BMI ≥ 40 kg/m2. Outcomes of interest included recurrent VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB). Results Eight studies comprising 30,895 patients were included. A total of 12,755 patients received xabans while 18,140 received VKAs. No significant difference in the odds of recurrent VTE (OR 0.75, 95% CI 0.55–1.01) and CRNMB (OR 0.69, 95% CI 0.44–1.09) was observed between the xabans group and the VKA group. However, the xabans group was associated with lower odds of major bleeding (OR 0.70, 95% CI 0.59–0.83). Conclusion Xabans have lower odds of major bleeding but similar odds of recurrent VTE when compared with VKAs in treating VTE in morbidly obese patients. Large registry analyses or future randomized controlled trials will be helpful in confirming these findings.https://doi.org/10.1186/s12872-023-03067-4Oral anticoagulantXabansVenous thromboembolismObesity |
| spellingShingle | Dae Yong Park Seokyung An Abdul Wahab Arif Muhammad Khawar Sana Aviral Vij Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis BMC Cardiovascular Disorders Oral anticoagulant Xabans Venous thromboembolism Obesity |
| title | Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis |
| title_full | Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis |
| title_fullStr | Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis |
| title_full_unstemmed | Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis |
| title_short | Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis |
| title_sort | factor xa inhibitors versus vitamin k antagonist in morbidly obese patients with venous thromboembolism a systematic review and meta analysis |
| topic | Oral anticoagulant Xabans Venous thromboembolism Obesity |
| url | https://doi.org/10.1186/s12872-023-03067-4 |
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