Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies

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Background: Data on the relationship between body mass index (BMI), thromboembolic events (TEE) and bleeding in patients with atrial fibrillation (AF) are controversial, and further evidence on the risk of such events in obese patients with AF receiving different anticoagulant therapies (OAC) is needed. Methods and results: We divided a total of 9330 participants from the prospective PREFER in AF and PREFER in AF PROLONGATION registries into BMI quartiles at baseline. Outcome measures were TEE and major bleeding complications at the 1-year follow-up. Without OAC, there was a ≥6-fold increase of TEE in the 4th vs other BMI quartiles (P =.019). OAC equalized the rates of TEE across different BMI strata. The occurrence of major bleeding was highest in patients with BMI in the 1st as well as in the 4th BMI quartile [OR 1.69, 95% CI 1.03–2.78, P =.039 and OR 1.86, 95% CI 1.13–3.04, P =.014 vs those in the 3rd quartile, respectively]. At propensity score-adjusted analysis, the incidence of TEE and major bleeding in obese patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K-antagonist anticoagulants (VKAs) was similar (P ≥.34). Conclusions: Our real-world data suggest no obesity paradox for TEE in patients with AF. Obese patients are at higher risk of TEE, and here OAC dramatically reduces the risk of events. We here found a comparable clinical outcome with NOACs and VKAs in obese patients. Low body weight and obesity were also associated with bleeding, and therefore OAC with the best safety profile should be considered in this setting.


  • Giuseppe Patti
  • Ladislav Pecen
  • Marius Constantin Manu
  • Kurt Huber
  • Miklos Rohla
  • Giulia Renda
  • Jolanta Siller-Matula
  • Fabrizio Ricci
  • Paulus Kirchhof
  • Raffaele De Caterina
Enheter & grupper
Externa organisationer
  • University Hospital of Novara
  • Charles University in Prague
  • Wilhelminenspital
  • University of Chieti-Pescara
  • Medical University of Vienna
  • Medical University of Warsaw
  • University of Birmingham
  • University Medical Center Hamburg-Eppendorf
  • University of Pisa
  • University of Eastern Piedmont
  • Institute of Computer Science of the Czech Academy of Sciences
  • Daiichi Sankyo Europe GmbH
  • Sigmund Freud Private University
  • Karl Landsteiner Gesellschaft Institute for Cardiometabolic Diseases
  • University Hospitals Birmingham

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kardiologi


Sidor (från-till)67-73
Antal sidor7
TidskriftInternational Journal of Cardiology
Tidigt onlinedatum2020 jun 21
StatusPublished - 2020 nov 1
Peer review utfördJa