Journal of Pharmacy Practice (JPP)A Real-World Comparison of Apixaban and Rivaroxaban in Obese and Morbidly Obese Patients with Nonvalvular Atrial Fibrillation

Study Sheds Light on Anticoagulant Choices for Obese Patients with NVAF, Reveals No Significant Differences in Key Outcomes

In a quest to optimize anticoagulant therapy for obese patients with nonvalvular atrial fibrillation (NVAF), a recent study compared the efficacy and safety of apixaban and rivaroxaban. The study aims to fill a gap in the current guidelines, which lack specific recommendations for anticoagulant use in this patient population.

HCN Medical Memo
For healthcare professionals managing obese patients with NVAF, this study suggests that both apixaban and rivaroxaban can be considered viable options, although the higher mortality rate in the apixaban group warrants further investigation. Until more comprehensive data are available, a patient-centered approach that considers both bleeding and thrombotic risks is recommended.

Key Points

• The study included 333 patients with a BMI ≥ 30 kg/m^2 diagnosed with NVAF, evaluating them for stroke, transient ischemic attack (TIA), myocardial infarction (MI), and atrial thrombosis.
• No significant differences were found in the primary composite endpoint between apixaban (3.8%) and rivaroxaban (1.7%) (P = .28).
• Bleeding events were slightly higher in the apixaban group (2.8%) compared to the rivaroxaban group (1.7%), but not statistically significant (P = .5).
• Overall mortality was higher in the apixaban group (3.8% vs 0%, P = .03).
• Healthcare professionals emphasize the need for more robust data to guide anticoagulant choice in obese patients with NVAF.

According to the American Heart Association, obese individuals are approximately 50% more likely to develop atrial fibrillation compared to those with a normal body mass index.

Additional Points

• The study was a retrospective chart review conducted at a single outpatient cardiovascular clinic.
• Limitations include a predominantly Caucasian sample and lack of compliance data.
• No identified variables were significantly associated with the composite primary endpoint.

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