Abstract:
INTRODUCTION:Due to fixed dosing of direct oral anticoagulants (DOACs), uncertainty exists about their efficacy in a population of obese/overweight patients. PATIENTS AND METHODS:We retrospectively investigated a real-life cohort of 325 DOAC anticoagulated patients with atrial fibrillation [179 receiving dabigatran (55%), 74 apixaban (23%) and 72 rivaroxaban (22%)]. Patients were stratified according to the body mass index (BMI) into non-obese (233 with BMI <30 kg/m2), class I obesity (71 with BMI 30-34.9 kg/m2) and class II + obesity (21 with BMI ≥35 kg/m2). RESULTS:Patients with higher BMI receiving DOACs were more likely to experience stroke/systemic embolism sooner (P = 0.043), experience major bleeding sooner (P < 0.001) and have shorter time to composite event consisting of thrombosis, bleeding or death (P < 0.001) whereas there was no significant association with overall survival (P = 0.470). BMI was significantly associated with thrombosis but not bleeding among dabigatran treated patients, and significantly associated with bleeding but not thrombosis among patients treated with factor Xa inhibitors. Associations of higher thrombotic, bleeding and composite endpoint risks with higher BMI remained statistically significant in multivariate Cox regression models adjusted for age, gender, eGFR, CHA2DS2VASC and HAS-BLED. CONCLUSION:Our findings indicate that obese patients receiving DOACs, especially ones with class II + obesity, might be under higher risks of stroke/bleeding depending on DOAC subtype. Loss of efficacy might be associated with dabigatran, whereas higher risk of major bleeding might be associated with factor Xa inhibitors.
journal_name
Int J Cardioljournal_title
International journal of cardiologyauthors
Lucijanic M,Jurin I,Jurin H,Lucijanic T,Starcevic B,Skelin M,Glasnovic A,Catic J,Jurisic A,Hadzibegovic Idoi
10.1016/j.ijcard.2019.10.035subject
Has Abstractpub_date
2020-02-15 00:00:00pages
90-95eissn
0167-5273issn
1874-1754pii
S0167-5273(19)34260-3journal_volume
301pub_type
杂志文章abstract:BACKGROUND:Focal vasospasm is reportedly involved in a high incidence of acute coronary syndrome (ACS) as compared with diffuse vasospasm. No adequate studies have been conducted on the mechanism underlying the higher incidence of ACS involving focal vasospasm than of those involving diffuse vasospasm in patients with ...
journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.ijcard.2008.03.071
更新日期:2009-06-26 00:00:00
abstract:BACKGROUND:Women with cardiac disease and their infants are at a greater risk of mortality and morbidity during pregnancy. Expert groups recommend preconception counseling (PCC) for all women with cardiac disease so they are made aware of these risks. We have run a specialist maternal cardiac clinic since 1996. The aim...
journal_title:International journal of cardiology
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abstract:BACKGROUND:Myocardial CCN2/CTGF (connective tissue growth factor) is strongly induced in heart failure (HF) and acts as a cardioprotective factor in ischemia/reperfusion injury. However, its functional role in myocardial hypertrophy remains unresolved. METHODS AND RESULTS:Transgenic mice with cardiac-restricted overex...
journal_title:International journal of cardiology
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abstract::We studied long-term variability of QT-dispersion in three patients with hypertrophic cardiomyopathy (Maron III) and ventricular fibrillation. Late potentials were absent on signal-averaged electrocardiogram. ST-segment depression was recorded in all three patients at Holter monitoring, and in two during exercise stre...
journal_title:International journal of cardiology
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doi:10.1016/0167-5273(94)90267-4
更新日期:1994-06-15 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.ijcard.2013.08.059
更新日期:2013-10-30 00:00:00
abstract:BACKGROUND AND AIM:The problem of a possible gender bias in coronary heart disease management is still controversial. We studied gender differences in secondary preventive drug prescriptions and in referral to cardiac rehabilitation after acute coronary events in France. METHODS:An observational survey was carried out...
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pub_type: 杂志文章,多中心研究
doi:10.1016/j.ijcard.2003.04.003
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abstract::Prompt treatment with thrombolytic therapy in acute myocardial infarction has been proven to reduce infarct size and mortality. However, reperfusion fails to occur in 30-50% of patients, either due to impaired epicardial artery flow or microvascular occlusion, with these patients experiencing a higher morbidity and mo...
journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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abstract:OBJECTIVES:The Seven Countries Study showed that fatal coronary heart disease (CHD) with only chronic heart failure, arrhythmia or blocks (atypical CHD, A-CHD) may represent a distinct disease as compared to fatal CHD cases with angina pectoris, acute myocardial infarction (AMI) or sudden death (typical CHD, T-CHD). We...
journal_title:International journal of cardiology
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journal_title:International journal of cardiology
pub_type: 杂志文章,meta分析,评审
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更新日期:1999-04-30 00:00:00
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journal_title:International journal of cardiology
pub_type: 信件
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.ijcard.2016.07.230
更新日期:2016-11-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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更新日期:2011-07-15 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/0167-5273(92)90267-7
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pub_type: 杂志文章
doi:10.1016/j.ijcard.2018.06.073
更新日期:2018-11-01 00:00:00
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pub_type: 信件
doi:10.1016/j.ijcard.2006.07.131
更新日期:2007-01-02 00:00:00
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pub_type: 杂志文章
doi:10.1016/0167-5273(90)90102-b
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pub_type: 信件
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更新日期:2020-12-02 00:00:00
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journal_title:International journal of cardiology
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pub_type: 杂志文章
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更新日期:2017-10-15 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ijcard.2013.03.036
更新日期:2013-10-03 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:1995-12-01 00:00:00
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journal_title:International journal of cardiology
pub_type: 评论,信件
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pub_type: 杂志文章
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更新日期:2000-05-31 00:00:00