{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:18:07Z","timestamp":1778473087534,"version":"3.51.4"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Atrial fibrillation (AF) and low body weight (BW, &lt;60\u2009kg) are common in patients with heart failure (HF). However, the safety and effectiveness of direct oral anticoagulants (DOACs) in this group remain unclear. This study compares the efficacy and safety of apixaban versus vitamin K antagonists (VKAs) in patients with nonvalvular AF, low BW and HF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed 155,152 patients with HF and AF, weighing \u2264100\u2009kg and treated with oral anticoagulants (apixaban 86,493; VKA 68,659), from the TriNetX Global Research Network. Outcomes included ischaemic stroke\/systemic embolism (SEE), clinically relevant bleedings, intracranial haemorrhage (ICH), all\u2010cause death and net clinical benefit (composite of stroke\/SEE, bleedings and all\u2010cause death) across three BW categories: 60\u2013100\u2009kg (reference), 50\u201360\u2009kg (low BW) and \u226450\u2009kg (very low BW). Propensity score matching was used to balance the treatment groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with low BW had a higher risk of adverse events compared to those with reference BW, regardless of treatment. Apixaban consistently reduced the risk of ischaemic stroke\/SEE and bleeding (including ICH) across all BW ranges (all <jats:italic>p<\/jats:italic>\u2010interaction &gt;.10), and improved net clinical benefit compared to VKA (reference BW: HR .82 [95% CI: .80\u2013.84]; low BW: HR .79 [95% CI: .74\u2013.85]; very low BW: HR .86 [95% CI: .78\u2013.95], <jats:italic>p<\/jats:italic>\u2010interaction\u2009=\u2009.366). However, a significant BW\u2010treatment interaction was observed for all\u2010cause mortality, indicating reduced relative effectiveness of apixaban vs. VKA as BW decreases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this large real\u2010world analysis, treatment with apixaban was associated with a superior effectiveness and safety profile compared to VKA in patients with AF, HF and low BW. These results remained consistent, albeit slightly attenuated, in patients with very low BW. These findings provide preliminary evidence supporting the use of apixaban in this high\u2010risk population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.70012","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T12:55:46Z","timestamp":1739796946000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Apixaban in patients with nonvalvular atrial fibrillation, heart failure and low body weight: A report from a global federated research dataset"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-943X","authenticated-orcid":false,"given":"Luca","family":"Monzo","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques Plurith\u00e9matique 1433 and Inserm U1116, CHRU Nancy, F\u2010CRIN INI\u2010CRCT (Cardiovascular and Renal Clinical Trialists)  Nancy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillaume","family":"Baudry","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques Plurith\u00e9matique 1433 and Inserm U1116, CHRU Nancy, F\u2010CRIN INI\u2010CRCT (Cardiovascular and Renal Clinical Trialists)  Nancy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gema","family":"Hernandez","sequence":"additional","affiliation":[{"name":"TriNetX Europe NV  Sint\u2010Martens\u2010Latem Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5403-4636","authenticated-orcid":false,"given":"Olivier","family":"Denquin","sequence":"additional","affiliation":[{"name":"TriNetX Europe NV  Sint\u2010Martens\u2010Latem Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Clinical Science and Education S\u00f6dersjukhuset; Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory Y. 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