Obesity Paradox in Atrial Fibrillation: Implications for Outcomes and Relationship With Oral Anticoagulant Drugs

Marco Proietti; Giuseppe Boriani


Am J Cardiovasc Drugs. 2020;20(2):125-137. 

In This Article

Relationship Between Obesity, Oral Anticoagulants (OACs), and Outcomes

The pharmacopeia for treating TEs in patients with AF has radically changed in recent years with the introduction of non-vitamin K antagonist oral anticoagulants (NOACs), which were found to have similar effectiveness to and to be safer than the older vitamin K antagonists (VKAs).[39–41] So far, only a few studies have investigated the differential effect of NOACs versus VKAs according to BMI classes (Table 2).

By analyzing the results from these studies, we can easily see how controversial data can be obtained about the variable effect of the different types of OACs according to BMI class (Table 2). In a first meta-analysis related to data from NOAC phase III trials, the authors not only documented an obesity paradox for stroke occurrence but also found a clear advantage for NOACs compared with VKAs in normal-weight patients for both stroke and major bleeding occurrence.[36]

A recent meta-analysis by Zhou et al.[38] published in this journal further extended the knowledge gathered by previous meta-analyses regarding the obesity paradox in AF. The preferential role of NOACs was confirmed in healthy-weight patients, whereas a more beneficial effect of NOACs was found for underweight patients.[38] Moreover, compared with the previous meta-analysis, a slightly beneficial effect from NOAC treatment was also found in overweight patients, whereas no difference was reported, in terms of both stroke and major bleeding occurrence, for obese patients.[38]