Direct oral anticoagulants and the risk of adverse clinical outcomes among patients with different body weight categories: a large hospital-based study.
Objective: Through predictable pharmacokinetics—including a convenient fixed-dose regimen, direct oral anticoagulants (DOACs) are preferred over previous treatments in anticoagulation for various indications. However, the association between higher body weight and the risk of adverse consequences is...
| Publicado en: | European Journal of Clinical Pharmacology Vol. 80; no. 1; pp. 163 - 174 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Jan2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=174712216&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 174712216 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00316970 NP9 jtl: European Journal of Clinical Pharmacology issn: 00316970 maglogo: N pubinfo: dt: Jan2024 vid: 80 iid: 1 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 174712216 173654370 174712216 174712216 10.1007/s00228-023-03593-2 174712216 ppf: 163 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Direct oral anticoagulants and the risk of adverse clinical outcomes among patients with different body weight categories: a large hospital-based study. aug: au: Nwanosike, Ezekwesiri Michael Merchant, Hamid A. Sunter, Wendy Ansari, Muhammad Ayub Conway, Barbara R. Hasan, Syed Shahzad affil: https://ror.org/05t1h8f27 Department of Pharmacy, School of Applied Sciences, University of Huddersfield, HD1 3DH, Queensgate, Huddersfield, UK sug: subj: Anticoagulants Administration and Dosage Administration, Oral Anticoagulants Adverse Effects Risk Assessment Body Weight Human Tertiary Health Care Structured Questionnaires Record Review Machine Learning Regression Kaplan-Meier Estimator Survival Analysis Hemorrhage Risk Factors Ischemic Stroke Risk Factors Hospital Mortality Length of Stay Obesity Paradox Descriptive Statistics Odds Ratio Confidence Intervals ab: Objective: Through predictable pharmacokinetics—including a convenient fixed-dose regimen, direct oral anticoagulants (DOACs) are preferred over previous treatments in anticoagulation for various indications. However, the association between higher body weight and the risk of adverse consequences is not well studied among DOAC users. We aim to explore the association of body weight and adverse clinical outcomes in DOAC users. Methods: A total of 97,413 anonymised DOAC users in a tertiary care setting were identified following structured queries on the electronic health records (EHRs) to extract the feature-rich anonymised dataset. The prepared dataset was analysed, and the features identified with machine learning (ML) informed the adjustments of covariates in the multivariate regression analysis to examine the association. Kaplan–Meier analysis was performed to evaluate the mortality benefits of DOACs. Results: Among DOAC users, the odds of adverse clinical outcomes, such as clinically relevant non-major bleeding (CRNMB), ischaemic stroke, all-cause mortality, and prolonged hospital stay, were lower in patients with overweight, obesity, or morbid obesity than in patients with normal body weight. The odds of ischaemic stroke (OR 0.42, 95% CI: 0.36–0.88, p = 0.001) and all-cause mortality (OR 0.87, 95% CI: 0.81–0.95, p = 0.001) were lower in patients with morbid obesity than in patients with normal body weight. In the Kaplan–Meier analysis, apixaban was associated with a significantly lower rate of mortality overall and in obesity and overweight subgroups than other DOACs (p < 0.001). However, rivaroxaban performed better than apixaban in the morbid obesity subgroup (p < 0.001). Conclusion: This study shows the positive effects of DOAC therapy on clinical outcomes, particularly in patients with high body weight. However, this still needs validation by further studies particularly among patients with morbid obesity. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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