Even Lightweights and Heavyweights Are Protected by Apixaban

Direct-acting oral anticoagulants (DOACs) are largely replacing warfarin for treating nonvalvular atrial fibrillation (AF), although warfarin might still be preferred for specific patient populations (e.g., people with mechanical heart valves). However, concern remains that the fixed dosing required for DOACs could overdose those with low body-mass index (BMI) and underdose those with high BMI. In a post hoc analysis of the manufacturer-sponsored ARISTOTLE trial (NCT00412984) which compared apixaban to warfarin in patients with AF and elevated stroke risk, researchers assessed treatment effect in patients stratified by weight (≤60 kg, >60–120 kg, and >120 kg).

Of over 18,000 randomized patients, 11% weighed ≤60 kg, and 5% weighed >120 kg. Ac…