Direct oral anticoagulants and the risk of adverse clinical outcomes among patients with different body weight categories: a large hospital-based study
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 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.
Direct oral anticoagulants, Electronic health records, England, Machine learning, Mortality, Obesity
163-173
Nwanosike, Ezekwesiri Michael
cfa7e99a-976a-43c3-8c46-00669d8e5da4
Merchant, Hamid A
16e7d300-a50c-480f-99f5-86e30e9274ec
Sunter, Wendy
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Ansari, Muhammad Ayub
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Conway, Barbara R
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Hasan, Syed Shahzad
e402cff7-ef4d-431e-8b82-905d3c8cfb89
January 2024
Nwanosike, Ezekwesiri Michael
cfa7e99a-976a-43c3-8c46-00669d8e5da4
Merchant, Hamid A
16e7d300-a50c-480f-99f5-86e30e9274ec
Sunter, Wendy
c667654f-5551-4aba-8d32-a24b96eebbe1
Ansari, Muhammad Ayub
7852fd5f-d9a8-4113-911a-533476958966
Conway, Barbara R
2c87aa00-8c01-480c-befb-6092900011c9
Hasan, Syed Shahzad
e402cff7-ef4d-431e-8b82-905d3c8cfb89
Nwanosike, Ezekwesiri Michael, Merchant, Hamid A, Sunter, Wendy, Ansari, Muhammad Ayub, Conway, Barbara R and Hasan, Syed Shahzad
(2024)
Direct oral anticoagulants and the risk of adverse clinical outcomes among patients with different body weight categories: a large hospital-based study.
European Journal of Clinical Pharmacology, 80 (1), .
(doi:10.1007/s00228-023-03593-2).
Abstract
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.
Text
s00228-023-03593-2
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Accepted/In Press date: 5 November 2023
e-pub ahead of print date: 18 November 2023
Published date: January 2024
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© 2023, The Author(s).
Keywords:
Direct oral anticoagulants, Electronic health records, England, Machine learning, Mortality, Obesity
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Local EPrints ID: 485157
URI: http://eprints.soton.ac.uk/id/eprint/485157
ISSN: 0031-6970
PURE UUID: 1dfa2836-27f3-4964-bfbf-cc9764876f40
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Date deposited: 30 Nov 2023 17:40
Last modified: 18 Mar 2024 04:17
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Contributors
Author:
Ezekwesiri Michael Nwanosike
Author:
Hamid A Merchant
Author:
Wendy Sunter
Author:
Muhammad Ayub Ansari
Author:
Barbara R Conway
Author:
Syed Shahzad Hasan
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