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Open AccessArticle

Effectiveness and Safety of Oral Anticoagulants among NVAF Patients with Obesity: Insights from the ARISTOPHANES Study

Ochsner Clinic Foundation, Department of Hospital Medicine, New Orleans, LA 70115, USA
Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA
STATinMED Research, Ann Arbor, MI 48108, USA
Bristol-Myers Squibb Company, Lawrenceville, NJ 08648, USA
Pfizer, Inc., Groton, CT 06340, USA
Pfizer, Inc., New York, NY 10017, USA
University of North Carolina, Chapel Hill, NC 27599, USA
New York City College of Technology, City University of New York, New York, NY 11201, USA
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L69 3BX, UK
Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1633;
Received: 10 April 2020 / Revised: 22 May 2020 / Accepted: 27 May 2020 / Published: 28 May 2020
(This article belongs to the Section Cardiology)
This ARISTOPHANES analysis examined stroke/systemic embolism (SE) and major bleeding (MB) among a subgroup of nonvalvular atrial fibrillation (NVAF) patients with obesity prescribed warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) in order to inform clinical decision making. A retrospective observational study was conducted among NVAF patients who were obese and initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013–30 September 2015, with data pooled from CMS Medicare and four US commercial claims databases. Propensity score matching was completed between NOACs and against warfarin in each database, and the results were pooled. Cox models were used to evaluate the risks of stroke/SE and MB. A total of 88,461 patients with obesity were included in the study. Apixaban and rivaroxaban were associated with a lower risk of stroke/SE vs. warfarin (HR: 0.63, 95% CI: 0.49–0.82 and HR: 0.84, 95% CI: 0.72–0.98). Dabigatran was associated with a similar risk of stroke/SE compared to warfarin. Compared with warfarin, apixaban and dabigatran had a lower risk of MB (HR: 0.54, 95% CI: 0.49–0.61 and HR: 0.75, 95% CI: 0.63–0.91). Rivaroxaban was associated with a similar risk of MB compared to warfarin. In this high-risk population with obesity, NOACs had a varying risk of stroke/SE and MB vs. warfarin. View Full-Text
Keywords: stroke; coagulation; outcomes; cardiovascular disease stroke; coagulation; outcomes; cardiovascular disease
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Deitelzweig, S.; Keshishian, A.; Kang, A.; Dhamane, A.D.; Luo, X.; Li, X.; Balachander, N.; Rosenblatt, L.; Mardekian, J.; Pan, X.; Di Fusco, M.; Garcia Reeves, A.B.; Yuce, H.; Lip, G.Y.H. Effectiveness and Safety of Oral Anticoagulants among NVAF Patients with Obesity: Insights from the ARISTOPHANES Study. J. Clin. Med. 2020, 9, 1633.

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