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Am J Cardiol. 2017 Jun 15;119(12):1989-1996. doi: 10.1016/j.amjcard.2017.03.028. Epub 2017 Mar 29.

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).

Author information

1
Halifax Regional Medical Center, Roanoke Rapids, North Carolina.
2
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
3
University of Cincinnati College of Medicine, Cincinnati, Ohio.
4
Bayer HealthCare Pharmaceuticals, Whippany, New Jersey.
5
University Hospital Münster, Münster, Germany.
6
University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
7
Ruprecht-Karls University, Heidelberg, Germany.
8
Icahn School of Medicine at Mount Sinai, New York, New York.
9
School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia.
10
Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California.
11
Janssen Research & Development, Raritan, New Jersey.
12
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
13
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: manesh.patel@duke.edu.

Abstract

We investigated stroke outcomes in normal weight (body mass index [BMI] 18.50 to 24.99 kg/m2), overweight (BMI 25.00 to 29.99 kg/m2), and obese (BMI ≥30 kg/m2) patients with atrial fibrillation treated with rivaroxaban and warfarin. We compared the incidence of stroke and systemic embolic events as well as bleeding events in normal weight (n = 3,289), overweight (n = 5,535), and obese (n = 5,206) patients in a post hoc analysis of 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. Stroke and systemic embolic event rates per 100 patient-years were 2.93 in the normal weight group (reference group), 2.28 in the overweight group (adjusted hazard ratio [HR] 0.81, 95% CI 0.66 to 0.99, p = 0.04) and 1.88 in the obese group (adjusted HR 0.69, 95% CI 0.55 to 0.86, p <0.001). The risk of stroke was statistically significantly lower for obese patients with BMI ≥35 than that for normal weight patients in both the rivaroxaban and warfarin groups (rivaroxaban: HR 0.62, 95% CI 0.40 to 0.96, p = 0.033; warfarin: HR 0.48, 95% CI 0.31 to 0.74, p <0.001). In conclusion, in patients with atrial fibrillation treated with anticoagulant therapy, increased BMI was associated with decreased stroke risk. Warfarin and the novel anticoagulant rivaroxaban are effective in stroke prevention in all subgroups of obese patients.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00403767.

PMID:
28477860
DOI:
10.1016/j.amjcard.2017.03.028
[Indexed for MEDLINE]

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