Impact of weight/BMI on clinical and bleeding events in 26 805 atrial fibrillation patients on edoxaban from the Global ETNA-AF Registry

AIMS: Body weight and body mass index (BMI) influence anticoagulation management in atrial fibrillation (AF) in interaction with age/comorbidities.

METHODS: The Global ETNA-AF programme collected data on AF patients receiving edoxaban in Europe and Asia. The relationship between body weight/BMI (as categorical and continuous variables) and 2-year clinical/bleeding event rates were analyzed.

RESULTS: In enrolled patients (n = 26 805), body weight was 72.2 ± 18.1 kg, and BMI was 26.4 ± 5.0 kg/m2 (mean ± standard deviation). Patients weighing ≤60 kg had the highest annualized rates of stroke/systemic embolic events (SEEs), death and bleeding. Patients >100 kg had the lowest bleeding and stroke/SEE event rates. Patients with BMI <18.5 kg/m2 had the worst adverse events, except for myocardial infarction. Analysis with restricted cubic splines showed relationships between body weight/BMI, and risk, were clearly U-shaped for cardiovascular (CV) and all-cause death. Specific cut-offs for higher risk were identified (Any stroke/SEE: BMI ≤20 kg/m2; haemorrhagic stroke: BMI ≤20 kg/m2, weight ≤53 kg; CV death: BMI ≤22 and ≥32 kg/m2, weight ≤62 kg; all-cause death: BMI ≤24 and ≥30 kg/m2, weight ≤69 kg and ≥118 kg relative to median BMI of 25.7 kg/m2 and median weight of 70 kg). The >60-≤80 kg weight group had the lowest death rate.

CONCLUSION: In a large cohort of AF patients, U-shaped relationships were found between body weight/BMI and all-cause/CV death at 2-year follow-up. Clinical monitoring of AF patients and associated comorbidities should be intensified at specific thresholds of low body weight and/or low BMI.