The risk for death in patients undergoing anticoagulation therapy for venous thromboembolism (VTE) was found to be lower in those who were morbidly obese vs those who had normal weight, according to a study published in Chest.
Data on demographics, clinical examinations, current therapies, and laboratory values were collected from the ongoing multicenter database, Registro Informatizado Enfermedad TromboEmbólica registry (ClinicalTrials.gov Identifier: NCT02832245). Follow-up data on anticoagulant therapy and potential VTE or major bleeds were collected at an outpatient clinic or by phone. Patients diagnosed with deep vein thrombosis or pulmonary embolism were classified according to their body mass index (BMI) as being morbidly obesity (BMI ≥40 kg/m²; n=1642) or having Fnormal weight (BMI, 18.5-24.9 kg/m²; n=14,848). Patients in the morbidly obese cohort were more frequently younger women with chronic lung or heart disease, diabetes, or hypertension. Outcomes were also examined in patients with vs without cancer. Active cancer was present in 14.9% of the morbidly obese group and in 28.3% of the patients in the normal weight group. Patients in the morbidly obese cohort with active cancer were most likely to have breast cancer. The primary outcome was death during anticoagulant therapy and the secondary outcomes were VTE recurrences or major bleeding.
Anticoagulant therapy had a longer duration in the morbidly obese vs normal weight cohort group, and patients who were morbidly obese and received low molecular-weight heparin were administered lower mean daily doses per body weight than patients with normal weight.
Patients in the morbidly obese group had lower mortality rates irrespective of cancer status compared with patients in the normal weight group (patients with cancer: hazard ratio [HR], 0.43; 95% CI, 0.32-0.58; patients without cancer: HR, 0.34; 95% CI, 0.25-0.45). The rate of VTE recurrence and major bleeding were similar between the 2 groups, irrespective of cancer status.
Study limitations include its observational design, the lack of standardizing weight measurement processes, and the sole calculation of BMI at the baseline.
“In patients with VTE, the risk for death during anticoagulation in morbidly obese patients was about one third lower than in those with normal weight, independently of the presence of cancer,” concluded the study authors.
Disclosure: This clinical trial was supported by Sanofi and Bayer Pharma AG. Please see the original reference for a full list of authors’ disclosures.
Giorgi-Pierfranceschi M, Núñez JJL, Monreal M, et al. Morbid obesity and mortality in patients with venous thromboembolism. Findings from real life clinical practice [published online January 29, 2020]. Chest. doi:10.1016/j.chest.2019.12.040