Findings from a recent study has demonstrated an association between higher baseline serum creatinine, elevated HASBLED score, and lower weight, with an increased risk of bleeding in patients with nonvalvular atrial fibrillation (NVAF) or atrial flutter (AFL) receiving a DOAC. These findings add to prescribing considerations when initiating DOACs,further suggesting that closer monitoring is advised for patients with significant renal dysfunction and/or low body weight, even with renal dose adjustments.
Atrial fibrillation (AF) increases the risk of stroke and direct oral anticoagulants (DOACs) are first-line agents for prevention. Gaps in the literature cause reluctance in prescribing DOACs for patients with renal dysfunction and/or extremes in body weight. Worldwide obesity has reached pandemic proportions with more than 1.9 billion adults classed as overweight in 2016, of which 650 million were obese. Since it is a major modifiable risk factor for so many cardiovascular diseases, it is no surprise there has been an exponential increase in cases of AF coinciding with the rise in obesity. While there were an estimated 8.8 million cases of AF in 2010 in Europe alone, by 2060, this is estimated to rise to 17.9 million. Moreover, obesity is now the second biggest attributable risk factor for AF after hypertension. Together with overweight, it accounted for 17.9% of all AF cases in the Atherosclerosis Risk in Communities (ARIC) study.
While AF risk appears to follow a linear pattern with increase in BMI, the pathophysiological basis of the obesity–AF relationship is complex and multifactorial. Indeed, various epidemiological studies have demonstrated an apparent paradox with regard to outcomes in AF patients; overweight and mildly obese patients with AF appear to have an overall better prognosis in terms of all-cause mortality compared with lean patients with AF. This is consistent with other cardiovascular diseases.
With this background, researchers undertook the present study to evaluate the impact of body weight and renal function have on major and clinically relevant nonmajor (CRNM) bleeding events and ischemic strokes in AF patients receiving a DOAC.
The present study consisted of a retrospective cohort study with adults with nonvalvular atrial fibrillation (NVAF) or atrial flutter (AFL) receiving a DOAC ≥12 months. The primary outcome was a composite of major and CRNM bleeding events. Secondary outcomes included ischemic stroke and risk factors for bleeding events.
Data analysis revealed the following facts.
· Of the 233 patients analyzed, 25 patients experienced a bleeding event. Patients who bled weighed 10 kg less (P = 0.043) than those who did not and had a higher HASBLED score (P = 0.003).
· Multivariate logistic regression identified weight (P = 0.048), serum creatinine (SCr; P = 0.027), and HASBLED score (P = 0.024) as the significant predictors for experiencing a bleed. Three patients experienced a stroke.

For full article follow the link: Whittemore H, Posen AK, Hellenbart EL, Groo V, Wenzler E, Tilton JJ. The impact of body weight and renal function on the risk of bleeding with direct oral anticoagulants. Ann. Pharmacother. 2021; doi: 10.1177/1060028021995201journals.sagepub.com/home/aop.
Primary source: Annals of Pharmacotherapy