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Liu M, Zhou Z, Ma X, Ma J, Wu X, Chen B, Tian Y. Multivariate logistic regression analysis to explore the high-risk factors of deep vein embolism/pulmonary embolism after knee replacement in the elderly. J Orthop Surg (Hong Kong) 2025; 33:10225536251345202. [PMID: 40424507 DOI: 10.1177/10225536251345202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2025] Open
Abstract
ObjectiveThis study aims to identify and quantify the high-risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE) in elderly patients undergoing total knee replacement (TKA).Methods621 patients who underwent TKA were divided into DVT/PE positive group (N = 52) and a negative group (N = 569).ResultStatistically significant differences were observed in the following factors: Caprini score (χ2 = 11.385, p < .001), prevalence of chronic obstructive pulmonary disease (COPD) (χ2 = 4.502, p = .034), history of heart failure (χ2 = 4.326, p = .012), duration of surgery (t = 3.723, p = .002), and early postoperative activity (χ2 = 4.014, p = .045). The incidence of DVT/PE was significantly higher in the very high-risk group compared to the high-risk group (9.89% vs 4.84%, χ2 = 2.080, p = .032). Multivariate logistic regression analysis identified the Caprini score as an extremely high-risk factor (adjusted OR = 2.87, 95% CI: 1.53-5.39, p = .001), alongside COPD (OR = 1.94, 95% CI: 1.08-3.48, p = .026), history of heart failure (OR = 1.68, 95% CI: 1.01-2.78, p = .048), and surgical duration exceeding 2 hours (OR = 1.35, 95% CI: 1.08-1.68, p = .008) as independent risk factors. The model, developed using multi-factor regression variables, demonstrates strong predictive performance for the occurrence of DVT/PE, with an area under the receiver operating characteristic curve of 0.842 (95%CI: 0.791-0.894).ConclusionIn elderly patients undergoing TKA, even with standard anticoagulation prophylaxis, a high Caprini risk score, COPD, a history of heart failure, and prolonged operative time remain independent risk factors for DVT. Early postoperative mobilization has been shown to have a protective effect.
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Affiliation(s)
- Ming Liu
- Department of Orthopedics, Yinchuan Guolong Orthopedic Hospital, Yinchuan, China
| | - Zhanwen Zhou
- Department of Orthopedics, Yinchuan Guolong Orthopedic Hospital, Yinchuan, China
| | - Xiaohu Ma
- Department of Orthopedics, Yinchuan Guolong Orthopedic Hospital, Yinchuan, China
| | - Jinguo Ma
- Department of Orthopedics, Yinchuan Guolong Orthopedic Hospital, Yinchuan, China
| | - Xiaojin Wu
- Department of Orthopedics, Yinchuan Guolong Orthopedic Hospital, Yinchuan, China
| | - Binghan Chen
- Department of Orthopedics, Yinchuan Guolong Orthopedic Hospital, Yinchuan, China
| | - Yanbin Tian
- Department of Orthopedics, Yinchuan Guolong Orthopedic Hospital, Yinchuan, China
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Liu Y, Lai H, Chen Z, Xiong G. Effect of low-dose rivaroxaban on bleeding events in low-weight patients with nonvalvular atrial fibrillation: a retrospective propensity score-matched cohort study. Front Cardiovasc Med 2024; 11:1495377. [PMID: 39606184 PMCID: PMC11599214 DOI: 10.3389/fcvm.2024.1495377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 10/29/2024] [Indexed: 11/29/2024] Open
Abstract
Objective To investigate the effect of low-dose rivaroxaban on bleeding events in low-weight patients with nonvalvular atrial fibrillation. Methods A retrospective study was conducted in patients with nonvalvular atrial fibrillation (weight ≤ 60 kg) who were admitted to the Department of Cardiology of Jiangxi Provincial People's Hospital from June 1, 2022, to December 12, 2022 and received anticoagulant therapy with rivaroxaban. The patients were divided into standard-dose group (15-20 mg) and low-dose group (10-15 mg). The patients were followed up for an average of 15 months by outpatient examination, telephone follow-up, or medical record inquiry of readmission patients. The bleeding events of the two groups were recorded during the follow-up period, and the two groups were balanced by propensity score weighting. Results A total of 198 patients with NVAF and body weight ≤60 kg receiving rivaroxaban anticoagulation therapy were enrolled, including 65 patients in the standard-dose group (15-20 mg) and 133 patients in the low-dose group (10-15 mg). In this study, only 24.1% (65/241) of the patients followed the standard dose of rivaroxaban. There was no significant difference in the incidence of bleeding events between the two groups after the balance of baseline characteristics (age) (P > 0.05). This was also consistent in patients weighing less than 50 kg. Conclusions In the real world, in lower-weight patients with nonvalvular atrial fibrillation, a reduced dose of rivaroxaban did not reduce the risk of bleeding, and this was consistent in patients weighing less than 50 kg.
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Affiliation(s)
- Yuan Liu
- Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hengli Lai
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhenhuan Chen
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Ganwei Xiong
- Department of Cardiology, The First People’s Hospital of Xiushui County, Jiujiang, China
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Elshafei MN, El-Bardissy A, Salem M, Abdelmoneim MS, Khalil A, Elhadad S, Danjuma M. Comparative Effectiveness and Safety of Direct Oral Anticoagulants Compared with Warfarin in Patients with Low Bodyweight who have Atrial Fibrillation: A Systematic Review and Meta-analysis. Am J Cardiovasc Drugs 2024; 24:255-271. [PMID: 38386247 PMCID: PMC10973089 DOI: 10.1007/s40256-024-00628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION oral anticoagulant (DOAC) agents are becoming the anticoagulation strategy of choice for most clinical risks for which they are indicated. However, residual uncertainty remains regarding their use in preventing stroke in patients with low bodyweight [< 60 kg or body mass index (BMI) < 18 kg/m2]. We have carried out pooled systematic analyses of published studies to determine the efficacy and safety of these agents compared with warfarin in stroke prevention in patients with low bodyweight. METHODS We carried out a comprehensive search of electronic databases from inception to June 2023 for eligible studies reporting on the efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation who had low bodyweight. These include PubMed, EMBASE, the Cochrane Database of Systematic Reviews, the Science Citation Index, and the Database of Abstracts of Reviews of Effectiveness. Using the random effects model, derived pooled odd ratios (with their corresponding confidence intervals) of mortality outcomes in patient cohorts exposed to direct oral anticoagulants versus warfarin in patients with atrial fibrillation who had low bodyweight. RESULTS Nine studies (n = 159,514 patients) were included in our meta-analysis. DOAC analogs were associated with lower stroke recurrence compared with warfarin [odds ratio (OR) 0.66, 95% confidence interval (CI) 0.49-0.9]; however, there was no significant difference in the composite outcome (OR 0.81, 95% CI 0.59-1.09) and mortality (OR 0.82, 95% CI 0.48-1.41). Additionally, DOAC analogs showed a significant reduction in major bleeding events by 30% compared with warfarin (OR 0.70, 95% CI 0.62-0.80). CONCLUSION In this pooled meta-analytical synthesis of studies comprising both real-world and randomized controlled data, the use of DOAC analogs in patients with atrial fibrillation and low bodyweight (< 60 kg or BMI < 18 kg/m2) was associated with a significant reduction in risks of stroke and major bleeding compared with patient cohorts stabilized on warfarin-based therapy. There was uncertainty regarding the composite outcome and mortality point estimate between these two anticoagulation strategies. This finding helps to resolve the uncertainty associated with the use of DOACs in this cohort. Additionally, it suggests the need for confirmatory non-inferiority randomized controlled trials evaluating DOACs versus warfarin in this cohort of patients.
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Affiliation(s)
- Mohamed Nabil Elshafei
- Clinical Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
- Department of Pharmacy, Hamad Medical Corporation (HMC), P.O.3050, Doha, Qatar.
| | - Ahmed El-Bardissy
- Clinical Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Salem
- Clinical Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Khalil
- Clinical Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammed Danjuma
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Rueda-Camino JA, Barba R, Otálora S, Bura-Riviere A, Visonà A, Mahé I, Alda-Lozano A, Alfonso Megido J, Pacheco-Gómez N, Rosovsky RP, Monreal M. Real life results of direct-acting oral anticoagulants recommended-dose in obese vs normal-weight patients with venous thromboembolism. Thromb Res 2024; 233:165-172. [PMID: 38070219 DOI: 10.1016/j.thromres.2023.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND There is scarce evidence on the effectiveness and safety of recommended-dose direct acting oral anticoagulants (DOACs) in obese patients with venous thromboembolism (VTE). MATERIAL AND METHODS We used the data in the RIETE registry to compare the rates of VTE recurrences and major bleeding during long-term therapy with DOACs at recommended doses in patients with body mass index ≥30 kg/m2 (obese) vs. those with BMI 18.5-24.9 kg/m2 (normal weight). We performed regression models with competing risks for death. RESULTS From January 2013 through October 2022, 2885 obese patients and 2676 with normal weight in RIETE received rivaroxaban (n = 3020), apixaban (n = 1754), edoxaban (n = 636) or dabigatran (n = 151). Median age was 63 years and 52 % were female. At baseline, obese patients were more likely to have diabetes (18.6 % vs. 8.4 %), hypertension (51.9 % vs. 31.4 %) or pulmonary embolism (67.7 % vs. 61 %), and less likely to have renal insufficiency (5.3 % vs. 16 %) or anaemia (21.8 % vs. 28 %%). During anticoagulation (median, 147 vs. 101 days), the obese had a similar rate of VTE recurrences (1.71 vs. 2.14 events per 100 patients-years; hazard ratio (HR): 0.81; 95 % CI: 0.49-1.34) or major bleeding (1.45 vs. 1.76 per 100 patients-years; HR: 0.91; 95 % CI: 0.52-1.59) than those with normal weight. These findings persisted after multivariable analysis (recurrent VTE, HR: 0.80; 95 % CI: 0.48-1.32; major bleeding, HR: 1.11; 95 % CI: 0.60-2.07). CONCLUSION The use of DOACs at recommended doses in obese patients with VTE was associated with similar rates of VTE recurrences or major bleeding than in patients with normal weight.
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Affiliation(s)
- José Antonio Rueda-Camino
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain; Health Research Institute Fundación Jiménez Díaz, Madrid, Spain.
| | - Raquel Barba
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain; Health Research Institute Fundación Jiménez Díaz, Madrid, Spain
| | - Sonia Otálora
- Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
| | | | - Adriana Visonà
- Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Assistance Publique des Hôpitaux de Paris (AP-HP), Colombes, France; Université Paris Cité, France, INSERM UMR-S-1140, Paris, France
| | - Alicia Alda-Lozano
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Navarra, Spain
| | | | | | - Rachel P Rosovsky
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Manuel Monreal
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Erstad BL, Barletta JF. Dilemmas Related to Direct-Acting Oral Anticoagulant Administration in Patients With Extreme Obesity. Ann Pharmacother 2022; 57:727-737. [PMID: 36258660 DOI: 10.1177/10600280221130456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of the study was to discuss the controversies surrounding the use and dosing of direct-acting oral anticoagulants (DOACs) in obese patients recognizing the limitations of the existing evidence base that preclude strong recommendations. DATA SOURCES A literature search of MEDLINE was performed (2020 to end August 2022) subsequent to recent guidelines using the following search terms: direct acting anticoagulants, obesity, rivaroxaban, apixaban, edoxaban, dabigatran, dabigatran etexilate, and clinical practice guidelines. STUDY SELECTION AND DATA ABSTRACTION English-language studies and those conducted in adults were selected. DATA SYNTHESIS The available randomized studies evaluating DOACs had relatively small numbers of patients with more extreme forms of obesity (body mass index [BMI] > 40 kg/m2) and none of the larger studies had a specific focus on dosing DOACs in obese patients. Recent guidelines by the International Society on Thrombosis and Haemostasis (ISTH) have specific recommendations for dosing DOACs in obesity. There are pharmacokinetic/pharmacodynamic and observational studies published before and after the ISTH guidelines with a focus on DOAC dosing in obese patients that generally support the recommendations in the guidelines, but most involved small numbers of patients usually with BMIs <45 kg/m2. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review discusses DOAC dosing in obesity with important considerations for clinicians related to DOAC choice and dosing. CONCLUSIONS Dosing alterations of DOACs do not appear to be necessary when used for either prophylaxis or treatment in patients with BMIs up to approximately 45 to 50 kg/m2, but research is needed for BMIs >50 kg/m2.
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Affiliation(s)
- Brian L Erstad
- Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ, USA
| | - Jeffrey F Barletta
- Department of Pharmacy Practice, College of Pharmacy-Glendale Campus, Midwestern University, Glendale, AZ, USA
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