{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:15:28Z","timestamp":1777936528053,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T00:00:00Z","timestamp":1724371200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100001502","name":"blue cross blue shield of michigan foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001502","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Direct oral anticoagulants (DOACs) have overtaken warfarin in the treatment of nonvalvular atrial fibrillation (AF) and venous thromboembolism (VTE). Limited data explore the safety of DOACs in obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This multicenter retrospective study between June 2015 and September 2019 uses the Michigan Anticoagulation Quality Improvement Initiative (MAQI\n                      <jats:sup>2<\/jats:sup>\n                      ) registry to compare DOACs and warfarin across weight classes (not obese: body mass index (BMI) \u2a7e 18.5 and &lt; 30; obese: BMI \u2a7e 30 and &lt; 40; severely obese: BMI \u2a7e 40). Primary outcomes include major, clinically relevant nonmajor (CRNM), and minor bleeding events per 100 patient-years. Secondary outcomes include stroke, recurrent VTE, and all-cause mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>DOACs were prescribed to 49% of the 4089 patients with AF and 46% of the 3162 patients with VTE. Compared to patients treated with warfarin, those treated with DOACs had a higher estimated glomerular filtration rate across BMI categories regardless of indication. In the AF population, severely obese patients treated with DOACs had more major (3.4 vs 1.8, p = 0.004), CRNM (8.6 vs 5.9, p = 0.019), and minor bleeding (11.4 vs 9.9, p = 0.001). There was no difference in stroke or all-cause mortality. In the VTE population, both CRNM (7.5 vs 6.7, p = 0.042) and minor bleeding (19.3 vs 10.5, p &lt; 0.001) events occurred at higher rates in patients treated with DOACs. There was no difference in recurrent pulmonary embolism, stroke, or all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>There is a higher rate of bleeding in severely obese patients with VTE and AF treated with DOACs compared to warfarin, without a difference in secondary outcomes. Further studies to compare the anticoagulant classes and understand bleeding drivers in this population are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x241264478","type":"journal-article","created":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T10:20:59Z","timestamp":1724408459000},"page":"543-552","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparing DOAC and warfarin outcomes in an obese population using the \u2018real-world\u2019 Michigan Anticoagulation Quality Improvement Initiative (MAQI\n                    <sup>2<\/sup>\n                    ) registry"],"prefix":"10.1177","volume":"29","author":[{"given":"Nelish","family":"Ardeshna","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA"},{"name":"Current: Department of Cardiology, Rush University Medical Center, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thane","family":"Feldeisen","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Michigan, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowen","family":"Kong","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Michigan, Ann Arbor, MI, USA"},{"name":"Michigan Anticoagulation Quality Improvement Initiative, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Haymart","sequence":"additional","affiliation":[{"name":"Michigan Anticoagulation Quality Improvement Initiative, MI, USA"},{"name":"Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Kaatz","sequence":"additional","affiliation":[{"name":"Michigan Anticoagulation Quality Improvement 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