For patients with nonvalvular atrial fibrillation and extremely low body weight, direct oral anticoagulants (DOACs) are safer and more effective than warfarin, according to results published in the Journal of the American College of Cardiology.

The study included participants with atrial fibrillation who had low body weight (≤50 kg) who were treated with oral anticoagulants and enrolled in the Korean National Health Insurance Service database from January 2014 to December 2014.

The researchers assessed participant outcomes for ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, major bleeding, all-cause death, and composite outcome. They used propensity score weighting to balance the groups.

In total, the study included 14,013 participants taking DOACs and 7576 taking warfarin. Baseline characteristics were similar between the groups, with a mean age of 73 years and mean CHA2DS2-VASc score of 4. Of the participants, 28% weighed <50 kg.

The results indicated that participants taking DOACs had lower risks for ischemic stroke (hazard ratio [HR], 0.591; 95% CI, 0.510-0.686) and major bleeding (HR, 0.705; 95% CI, 0.601-0.825), which were caused by a reduction in intracranial hemorrhage (HR, 0.554; 95% CI, 0.429-0.713), compared with those taking warfarin.

Compared with warfarin, DOACs were more effective at improving the net clinical benefit (HR for composite outcome, 0.660; 95% CI, 0.606-0.717).

This result remained consistent even for participants who weighed <50 kg (HR for composite outcome, 0.665; 95% CI, 0.581-0.762).

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The researchers also found that reduced doses of DOACs showed similar efficacy and safety compared with regular doses.

Reference

Lee S, Choi E, Park CS, et al. Direct oral anticoagulants in patients with nonvalvular atrial fibrillation and low body weight. J Am Coll Cardiol. 2019;73(8):919-931.