Direct Oral Anticoagulants and Warfarin Safety in Rural Patients with Obesity.

Document Type


Publication Date


Publication Title

The American journal of the medical sciences


oregon; astoria; seaside; california; phcmc; cards; cards publication


Background: Direct oral anticoagulants (DOACs) are often used in patients with atrial fibrillation or flutter instead of warfarin and, although supporting evidence is limited, available studies suggest this may be an acceptable route of care. Our study assessed the question: are DOACs as effective and safe as warfarin in patients with atrial fibrillation and class III obesity specifically in a rural population?

Methods: A retrospective analysis was conducted by examining the first 6-12 months of therapy with a DOAC (apixaban or rivaroxaban) or warfarin in patients with weight >120kg or class III obesity. Events of interest, thrombosis and bleeding, were documented for analysis. The risk and odds of an event of interest for both groups were calculated and compared.

Results: Characteristics of both arms were similar (DOAC n=42; warfarin n=43). A lack of thrombosis events limited efficacy analysis. A total of 22 bleeds occurred with 8 in patients prescribed a DOAC (7 minor; 1 major) and 14 in those prescribed warfarin (12 minor; 2 major). Weight in kg (p

Conclusions: In patients with atrial fibrillation and class III obesity, regarding safety, DOACs appear to be non-inferior to warfarin during the first six to 12 months of therapy in our rural population - consistent with other analyses; however, the lack of thrombosis events limited the efficacy analysis.

Clinical Institute

Digestive Health

Clinical Institute

Cardiovascular (Heart)