Meta-analysis on efficacy and safety of new oral anticoagulants for venous thromboembolism prophylaxis in overweight and obese postarthroplasty patients

Ranjan Pathak, Paras Karmacharya, Smith Giri, Dilli Ram Poudel, Madan Raj Aryal, Vijaya Raj Bhatt, Fadi E. Shamoun, Anil Pandit

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Obesity is an independent risk factor for venous thromboembolism (VTE), and the risk rises further in the postarthroplasty period. Although medication doses often require adjustment for the altered pharmacokinetic profile in obese patients, the efficacy and safety of a fixed-dose regimen of new oral anticoagulants (NOACs) in overweight and obese patients remain unclear. Relevant studies were identified through searches of major databases. Phase III randomized controlled trials that compared NOACs against low-molecular-weight heparin (LMWH) in the prevention of VTE in postarthroplasty patients were included. Efficacy and safety outcomes with NOACs in overweight (BMI 25-29 kg/m2) and obese (BMI-30 kg/m2) patients were assessed. In five trials involving 16 674 patients, NOACs were found similar to LMWH in preventing VTE and VTE-related deaths after arthroplasty in both overweight and obese patients [odds ratio (OR) 0.64, PU0.19 and OR 0.76, PU0.43, respectively]. Similarly, the risk of major or clinically relevant bleeding was similar to LMWH in overweight patient with a trend toward lower bleeding in obese patients (OR 0.83, PU0.54 and OR 0.44, PU0.07 respectively). Apixaban was found to be more effective than LMWH in obese patients (OR 0.54, PU0.01) with the lower dose of dabigatran (150 mg) being less effective (OR 1.81, PU0.02). Our study suggests that a fixed-dose regimen of dabigatran might be ineffective in severe obesity. However, apixaban at the currently recommended dose seems to be superior to LMWH in obese patients with noninferior bleeding risk.

Original languageEnglish (US)
Pages (from-to)635-642
Number of pages8
JournalBlood Coagulation and Fibrinolysis
Volume26
Issue number6
DOIs
StatePublished - Sep 1 2015

Fingerprint

Venous Thromboembolism
Anticoagulants
Meta-Analysis
Safety
Low Molecular Weight Heparin
Odds Ratio
Hemorrhage
Morbid Obesity
Patient Safety
Arthroplasty
Randomized Controlled Trials
Pharmacokinetics
Obesity
Databases

Keywords

  • Apixaban
  • Dabigatran
  • Meta-analysis
  • New oral anticoagulants
  • NOAC
  • Obese
  • Overweight
  • Rivaroxaban
  • Venous thromboembolism prophylaxis

ASJC Scopus subject areas

  • Hematology

Cite this

Meta-analysis on efficacy and safety of new oral anticoagulants for venous thromboembolism prophylaxis in overweight and obese postarthroplasty patients. / Pathak, Ranjan; Karmacharya, Paras; Giri, Smith; Poudel, Dilli Ram; Aryal, Madan Raj; Bhatt, Vijaya Raj; Shamoun, Fadi E.; Pandit, Anil.

In: Blood Coagulation and Fibrinolysis, Vol. 26, No. 6, 01.09.2015, p. 635-642.

Research output: Contribution to journalArticle

Pathak, Ranjan ; Karmacharya, Paras ; Giri, Smith ; Poudel, Dilli Ram ; Aryal, Madan Raj ; Bhatt, Vijaya Raj ; Shamoun, Fadi E. ; Pandit, Anil. / Meta-analysis on efficacy and safety of new oral anticoagulants for venous thromboembolism prophylaxis in overweight and obese postarthroplasty patients. In: Blood Coagulation and Fibrinolysis. 2015 ; Vol. 26, No. 6. pp. 635-642.
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