Real-World Efficacy and Safety of DOACs vs Warfarin in Atrial Fibrillation and Venous Thromboembolism Obese Patients: Propensity Matching Analysis

Background/Objectives: The use of direct oral anticoagulants (DOACs) in obese patients is scarcely studied despite having many advantages over warfarin. Consequently, this study aims to assess the real‐world safety and effectiveness of DOACs compared to warfarin in treating atrial fibrillation (AF) and venous thromboembolism (VTE) in obese patients. Methods: A brief description of the main methods or treatments applied. This can include any relevant preregistration or specimen information. Results: We identified 959 patients treated with either a direct oral anticoagulant (DOAC) (519) or warfarin (440). Their average age was 76, with a mean CHA2DS2‐VASc score of 4.9 ± 1.97. Compared to warfarin, DOAC therapy was correlated with a lower incidence of all‐cause mortality (21.2% vs. 32.9%, p<0.001). The incidence of stroke (4.0% vs. 4.9%, p=0.507), venous thromboembolism (VTE) (1.9% vs. 3.1%, p=0.269), and a trend to lower bleeding events (4.2% vs. 6.8%, p=0.099). Even when adjusting for additional risk factors, there is a trend to a lower risk of mortality associated with DOAC usage compared to warfarin, though the adjusted hazard ratio was statistically insignificant (0.780; 95% CI = 0.60 to 1.02; p=0.069). Conclusions: Compared to warfarin, the efficacy of DOAC therapy was similar, while its safety wasoutstanding in obese patients with non‐valvular AF or VTE. Therefore, considering DOACs as analternative to warfarin in obese patients would be logical.