Dabigatran Use and Cerebrovascular Event Risk Across Body Mass Index in Atrial Fibrillation: A Real-World Nested Case-Control Study
Loading...
Files
Size: 1 MB, File format: Adobe PDF
Date
Authors
Mahawish, Karim M
Feigin, Valery
Barber, P Alan
Bennett, Derrick A
Krishnamurthi, Rita
White, Harvey D
Supervisor
Item type
Degree name
Journal Title
Journal ISSN
Volume Title
Publisher
Springer
Abstract
Dabigatran is widely used for stroke prevention in atrial fibrillation (AF), but concerns remain regarding its effectiveness in patients with Class III obesity ( BMI ≥40 kg/m2.) We evaluated the association between dabigatran use in patients with AF and ischaemic stroke (IS) or transient ischaemic attack (TIA) across body mass index (BMI) categories in a multiethnic New Zealand population. In this retrospective nested case-control study, cases with incident IS/TIA were identified from the fifth Auckland Regional Community Stroke Study (1st September 2020-31st August 2021), and event-free controls were randomly selected from the National Minimum Dataset. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for IS/TIA, and effect modification by BMI catergory (< 30, 30-39.9, ≥40 kg/m2) was assessed using an interaction term. Among 1,854 patients with AF (295 cases, 1,559 controls), dabigatran use was associated with lower odds of IS/TIA (adjusted odds ratio [aOR] 0.50, 95% CI 0.38-0.68). After multivariable adjustment, BMI was not independently associated with IS/TIA risk. The association between dabigatran use and lower IS/TIA risk was similar in patients with BMI <30 and 30-39.9 kg/m2, but the point estimate shifted towards the null in patients with BMI ≥40 kg/m2 and was imprecise. There was no statistical evidence of effect modification by BMI (p-interaction=0.49), although clinically important attenuation in Class III obesity could not be excluded. In this real-world nested case-control study, there was no clear statistical evidence of BMI-related effect modification; however, the study had limited power in patients with BMI ≥40 kg/m2, and clinically important attenuation, including the possibility of no reduction in IS/TIA odds with dabigatran use in Class III obesity cannot be excluded.
Description
Keywords
Atrial fibrillation, Dabigatran, Ischaemic stroke, Obesity, Transient ischaemic attack, 32 Biomedical and Clinical Sciences, 3201 Cardiovascular Medicine and Haematology, 3202 Clinical Sciences, Health Disparities and Racial or Ethnic Minority Health Research, Brain Disorders, Cerebrovascular, Cardiovascular, Stroke, Heart Disease, Prevention, 2.1 Biological and endogenous factors, 1103 Clinical Sciences, Cardiovascular System & Hematology, 3201 Cardiovascular medicine and haematology, 3202 Clinical sciences
Source
Journal of Thrombosis and Thrombolysis, ISSN: 0929-5305 (Print); 1573-742X (Online), Springer, 1-10. doi: 10.1007/s11239-026-03394-1
Publisher's version
Rights statement
Permanent link
Endorsement
Review
Supplemented By
Referenced By
Creative Commons license
Except where otherwise noted, this item's license is described as Creative Commons Attribution 4.0 International License