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Prevention of thromboembolic complications in patients with atrial fibrillation and obesity
| 1 | I Oddział Kardiologii i Angiologii, Śląskie Centrum Chorób Serca w Zabrzu / 1st Department of Cardiology and Angiology, Silesian Center for Heart Diseases in Zabrze |
| 2 | Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii, Oddział Kliniczny Kardiologii, Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach / Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland |
CORRESPONDING AUTHOR
Izabela Kolasa
I Oddział Kardiologii i Angiologii, Śląskie Centrum Chorób Serca w Zabrzu, ul. Marii Curie-Skłodowskiej 9, 41-800 Zabrze
I Oddział Kardiologii i Angiologii, Śląskie Centrum Chorób Serca w Zabrzu, ul. Marii Curie-Skłodowskiej 9, 41-800 Zabrze
Ann. Acad. Med. Siles. 2023;77:60–66
KEYWORDS
atrial fibrillationobesitythromboembolic complicationsvitamin K antagonistsnon-vitamin K antagonists oral anticoagulants
TOPICS
ABSTRACT
Atrial fibrillation (AF) is an arrhythmia that occurs in 1–2% of the population. Chronic oral anticoagulation is recommended in the group of patients with AF to prevent thromboembolic complications. Obesity is a factor contributing to the development and progression of AF, and the use of oral anticoagulants in patients with excess body fat may be difficult.
Vitamin K antagonist (VKA) and non-vitamin K antagonist oral anticoagulants (NOAC) are commonly used. For VKA in obese patients, a longer time and a higher dose of drugs should be expected to achieve the target international normalized ratio (INR) values. It is not known whether the therapeutic range of INR should change with the body mass index (BMI) or body weight.
NOACs include factor Xa inhibitors and direct thrombin inhibitors. The use of NOAC in obese patients has been proven to be effective and safe. In the group of patients with AF and morbid obesity or with a body weight > 120 kg, the use of VKA or determination of the plasma concentration should be considered in the prevention of thromboembolic complications due to the limited amount of data.
REFERENCES (30)
1.
Obesity and overweight. World Health Organization [online], 9 June 2021, https://www.who.int/news-room/... [dostęp: 14 września 2022].
2.
Cukier, otyłość – konsekwencje. Przegląd literatury, szacunki dla Polski [pdf]. Narodowy Fundusz Zdrowia, Departament Analiz i Strategii, 21 lutego 2019, https://ezdrowie.gov.pl/pobier... [dostęp: 14 września 2022].
3.
Pruszczyk P., Stępińska J., Banasiak W., Członkowska A., Opolski G., Niewada M. i wsp. Zastosowanie nowych doustnych leków przeciwkrzepliwych w prewencji powikłań zatorowych u chorych z migotaniem przedsionków. Kardiol. Pol. 2012; 70(9): 979–988.
4.
Sredniawa B., Mitrega K., Stokwiszewski J., Sokal A., Boidol J., Wierucki L. i wsp. Screening for atrial fibrillation in subjects aged 65 using a long-term continuous ECG telemonitoring vest: the NOninvasive Monitoring for early detection of atrial fibrillation (NOMED-AF) study. Eur. Heart J. 2020; 41(Suppl. 2), doi: 10.1093/ehjci/ehaa946.0503.
5.
Hindricks G.,Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström‑Lundqvist C. i wsp. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021; 42(5): 373–498, doi: 10.1093/eurheartj/ehaa612.
6.
Dyba J., Surdacka A. Otyłość – epidemia XXI wieku. Dental Forum 2019; 47(1): 29–35, doi: 10.20883/df.2019.4.
7.
Szymocha M., Bryła M., Maniecka-Bryła I. Epidemia otyłości w XXI wieku. Zdr. Publ. 2009; 119(2): 207–212.
8.
Świątkowska-Stodulska R., Kazimierska E., Sworczak K., Częstochowska E. Zaburzenia hemostazy u osób otyłych. Wiad. Lek. 2007; 60(3–4): 185–188.
9.
Rocca B., Fox K.A.A., Ajjan R.A., Andreotti F., Baigent C., Collet J.P. i wsp. Antithrombotic therapy and body mass: an expert position paper of the ESC Working Group on Thrombosis. Eur. Heart J. 2018; 39(19): 1672–1691, doi: 10.1093/eurheartj/ehy066.
10.
Woźnicka-Leśkiewicz L., Wolska-Bułach A., Tykarski A. Interakcje antykoagulantów z lekami i żywnością — wskazówki dla lekarza praktyka. Chor. Serca Naczyń 2014; 11(2): 78–90.
11.
Mueller J.A., Patel T., Halawa A., Dumitrascu A., Dawson N.L. Warfarin dosing and body mass index. Ann. Pharmacother. 2014; 48(5): 584–588, doi: 10.1177/1060028013517541.
12.
Drzewoski J., Watała C. Riwaroksaban i dabigatran — nowe możliwości prewencji żylnej choroby zakrzepowo-zatorowej i jej powikłań. Chor. Serca Naczyń 2011; 8(4): 197–208.
13.
Steffel J., Collins R., Antz M., Cornu P., Desteghe L., Haeusler K. i wsp. 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10): 1612–1676, doi: 10.1093/europace/euab065.
14.
Patel M.R., Mahaffey K.W., Garg J., Pan G., Singer D.E., Hacke W. i wsp. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N. Engl. J. Med. 2011; 365(10): 883–891, doi: 10.1056/NEJMoa1009638.
15.
Tomkowski W. Nowo zarejestrowane leki przeciwzakrzepowe: rywaroksaban i dabigatran. Hematologia 2010; 1(2): 151–156.
16.
Balla S.R, Cyr D.D., Lokhnygina Y.L., Becker R.C., Berkowitz S.D., Breithardt G. i wsp. Relation of risk of stroke in patients with atrial fibrillation to body mass index (from patients treated with rivaroxaban and warfarin in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation trial). Am. J. Cardiol. 2017; 119(12): 1989–1996, doi: 10.1016/j.amjcard.2017.03.028.
17.
Peterson E.D., Ashton V., Chen Y.W., Wu B., Spyropoulos A.C. Comparative effectiveness, safety, and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation. Am. Heart J. 2019; 212: 113–119, doi: 10.1016/j.ahj.2019.02.001.
18.
Costa O.S., Beyer-Westendorf J., Ashton V., Milentijevic D., Moore K.T., Bunz T.J. i wsp. Effectiveness and safety of rivaroxaban versus warfarin in obese nonvalvular atrial fibrillation patients: analysis of electronic health record data. Curr. Med. Res. Opin. 2020; 36(7): 1081–1088, doi: 10.1080/03007995.2020.1762554.
19.
Szpotowicz A., Gorczyca-Michta I., Krzciuk M., Wożakowska-Kapłon B. Apiksaban w codziennej praktyce klinicznej – dla jakiej grupy pacjentów? Chor. Serca Naczyń 2016; 13(6): 424–428.
20.
Upreti V.V., Wang J., Barrett Y.C., Byon W., Boyd R.A., Pursley J. i wsp. Effect of extremes of body weight on the pharmacokinetics, pharmacodynamics, safety and tolerability of apixaban in healthy subjects. Br. J. Clin. Pharmacol. 2013; 76(6): 908–916, doi: 10.1111/bcp.12114.
21.
Szczerba E. Apiksaban skuteczniejszy i bezpieczniejszy od warfaryny u pacjentów z migotaniem przedsionków: badanie ARISTOTLE. Kardiol. Pol. 2012; 70(2): 196–198.
22.
Hohnloser S.H., Fudim M., Alexander J.H., Wojdyla D.M., Ezekowitz J.A., Hanna M. i wsp. Efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation and extremes in body weight. Circulation 2019; 139(20): 2292–2300, doi: 10.1161/CIRCULATIONAHA.118.037955.
23.
Sandhu R.K., Ezekowitz J.A., Hijazi Z., Westerbergh J., Aulin J., Alexander J.H. i wsp. Obesity paradox on outcome in atrial fibrillation maintained even considering the prognostic influence of biomarkers: insights from the ARISTOTLE trial. Open Heart 2018; 5(2): e000908, doi: 10.1136/openhrt-2018-000908.
24.
Witkowski M., Witkowska M., Smolewski P. Najnowsze zalecenia dotyczące zastosowania nowych doustnych antykoagulantów w rutynowej praktyce. Postepy Hig. Med. Dosw. 2016; 70: 43–55.
25.
Giugliano R.P., Ruff C.T., Braunwald E., Murphy S.A., Wiviott S.D., Halperin J.L. i wsp. Edoxaban versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2013; 369(22): 2093–2104, doi: 10.1056/NEJMoa1310907.
26.
Boriani G., De Caterina R., Manu M.C., Souza J., Pecen L., Kirchhof P. Impact of weight on clinical outcomes of edoxaban therapy in atrial fibrillation patients included in the ETNA-AF-Europe registry. J. Clin. Med. 2021; 10(13): 2879, doi: 10.3390/jcm10132879.
27.
Connolly S.J., Ezekowitz M.D., Yusuf S., Eikelboom J., Oldgren J., Parekh A. i wsp. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2009; 361(12): 1139–1151, doi: 10.1056/NEJMoa0905561.
28.
Reilly P.A., Lehr T., Haertter S., Connolly S.J., Yusuf S., Eikelboom J.W. i wsp. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J. Am. Coll. Cardiol. 2014; 63(4): 321–328, doi: 10.1016/j.jacc.2013.07.104.
29.
Kasprzak J.D., Dąbrowski R., Barylski M., Mamcarz A., Wełnicki M., Filipiak K.J. i wsp. Doustne antykoagulanty nowej generacji – aspekty praktyczne. Stanowisko Sekcji Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego. Folia Cardiol. 2016; 11(5): 377–393, doi: 10.5603/FC.2016.0064.
30.
Proietti M., Guiducci E., Cheli P., Lip G.Y.H. Is there an obesity paradox for outcomes in atrial fibrillation? A systematic review and meta-analysis of Non-Vitamin K Antagonist Oral Anticoagulant trials. Stroke 2017; 48(4): 857–866, doi: 10.1161/STROKEAHA.116.015984.
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