159 Safety and Efficacy of Direct Oral Anticoagulants in Patients with Body Mass Index ≥40 kg/m2

Introduction: Obesity is a risk factor for venous thromboembolism (VTE) and atrial fibrillation (AF).Warfarin has been the preferred anticoagulant due to ability to monitor INR and due to limited data in use of DOACs and concern for decreased drug exposure.This study aims to determine if the safety and efficacy of DOACs in patients with BMI 40 kg/m 2 is similar to patients with BMI <40 kg/m 2 Methods: This study was a single-center, retrospective chart review.Adults with BMI 40 kg/m 2 or BMI <40 kg/m 2 taking a DOAC for AF or VTE were included in the study.Patients were matched based on age, sex, indication, and DOAC dose.The primary efficacy outcome was composite of VTE ischemic stroke.The primary safety outcome was a composite of major and clinically relevant non-major bleeding.The secondary outcome was assessment of predictors for thrombotic or bleeding events.Results: A total of 107 patients were included in each group.There was no significant difference in the composite thrombotic and bleeding outcomes between the groups.After accounting for age, sex, renal function, indication, history of VTE/TIA/CVA, history of major bleeding, DOAC medication, and concomitant antiplatelet use, BMI 40 was not a significant predictor for a composite thrombotic event. Conclusion:The results of this study add to the growing body of literature demonstrating that DOACs are a reasonable alternative for obese patients with AF or VTE.Larger studies are needed to further evaluate the efficacy and safety of DOACs in this population.