4.5 Review

Comparing the Clinical Outcomes Observed with Rivaroxaban Versus Warfarin for the Management of Obese Patients with Non-valvular Atrial Fibrillation: a Systematic Review and Meta-analysis

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Summary: In patients with nonvalvular atrial fibrillation and obesity, rivaroxaban is associated with a lower risk of stroke and systemic embolism compared to warfarin, while the risk of major bleeding is similar. The results are consistent across different polypharmacy categories.

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Summary: Obesity is an independent risk factor for atrial fibrillation, contributing to its substrate through various pathways. Treatment considerations for atrial fibrillation patients must account for changes in pharmacokinetics and pharmacodynamics, while weight loss has been shown to prevent progression of AF.

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Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Obese Patients with Atrial Fibrillation

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Summary: In a cohort of obese patients with atrial fibrillation, DOACs were associated with lower risk of hemorrhagic complications compared to warfarin, while maintaining effectiveness in preventing ischemic stroke.

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Safety and Efficacy of Rivaroxaban and Apixaban in Patients with Increased Body Mass: a Systematic Review

Margaret M. Buck et al.

Summary: The study revealed that in patients with increased body mass, rivaroxaban and apixaban showed similar or lower rates of bleeding and thrombotic risk compared to patients with normal body mass. Further prospective controlled studies are needed to define guidelines for the use of these medications in this population.

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Jeffrey S. Berger et al.

Summary: This study demonstrated that rivaroxaban is an effective and safe treatment option for NVAF patients with obesity in a commercially-insured US population, with a 26% lower risk of stroke/SE compared to warfarin at 36 months post-treatment initiation. The risk of major bleeding was similar between rivaroxaban-initiated patients and warfarin-initiated patients.

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Body Mass Index Influence on the Clinical Outcomes for Nonvalvular Atrial Fibrillation Patients Admitted to a Hospital Treated with Direct Oral Anticoagulants: A Retrospective Cohort Study

Xiaoye Li et al.

Summary: This study compared the effectiveness and safety of dabigatran and rivaroxaban in different BMI populations, finding that rivaroxaban may carry a risk of insufficient anticoagulation effect in patients with high BMI. Obese patients may require an increased dose of rivaroxaban. Overall, the use of DOACs appears to be safe in obese patients.

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Effectiveness and safety of rivaroxaban versus warfarin among nonvalvular atrial fibrillation patients with obesity and diabetes

Matthew R. Weir et al.

Summary: Rivaroxaban was associated with lower risks of stroke/systemic embolism in NVAF patients with comorbidities of obesity and diabetes, when compared to warfarin. However, the risk of major bleeding was similar between the two treatment groups.

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AH Abdelhafiz

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