Temporal Trends in Direct-Acting Oral Anticoagulants Use Among Patients at Extremes of Body Weight: Insight From PINNACLE Registry.
| Title: | Temporal Trends in Direct-Acting Oral Anticoagulants Use Among Patients at Extremes of Body Weight: Insight From PINNACLE Registry. |
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| Authors: | Al Badarin F; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.; Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.; Elkaryoni A; Department of Cardiology, Brown University, Providence, RI.; Wimmer A; Saint Luke's Mid America Heart Institute, Kansas City, MO.; Kansas City's Healthcare Institute for Innovations in Quality, University of Missouri, Kansas, MO.; Sadhu JS; Cardiovascular Division, Washington University in St. Louis School of Medicine, St. Louis, MO.; Fu Z; Saint Luke's Mid America Heart Institute, Kansas City, MO.; Jones P; Saint Luke's Mid America Heart Institute, Kansas City, MO.; Spertus JA; Saint Luke's Mid America Heart Institute, Kansas City, MO.; Kansas City's Healthcare Institute for Innovations in Quality, University of Missouri, Kansas, MO. |
| Source: | Mayo Clinic proceedings. Innovations, quality & outcomes [Mayo Clin Proc Innov Qual Outcomes] 2026 Apr 24; Vol. 10 (3), pp. 100692. Date of Electronic Publication: 2026 Apr 24 (Print Publication: 2026). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Inc Country of Publication: Netherlands NLM ID: 101728275 Publication Model: eCollection Cited Medium: Internet ISSN: 2542-4548 (Electronic) Linking ISSN: 25424548 NLM ISO Abbreviation: Mayo Clin Proc Innov Qual Outcomes Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Netherlands] : Elsevier Inc., [2017]- |
| Abstract: | Objective: To describe temporal changes in direct oral anticoagulant (DOAC) use across the range of body mass index (BMI) and understand factors associated with its use.; Patients and Methods: Outpatients with atrial fibrillation (AF) eligible for systemic anticoagulation in the PINNACLE Registry (January 1st, 2014-September 30th, 2021) were identified, and mixed-effects logistic regression was used to assess the association between DOAC use and BMI, after adjusting for patient characteristics, with an interaction between BMI and calendar year to describe temporal changes in practice.; Results: Of 950,644 patients with nonvalvular AF with a CHA2DS2-VASc score of ≥2 and no previous bleeding who were receiving oral anticoagulation, 66.4% were treated with DOAC, which markedly increased between 2014 and 2021 (40.2% and 84.4%, respectively). Although BMI was nonlinearly associated with DOAC use (P interaction=.0002), differences in DOAC use across BMI were small with rates of 63.2% in underweight patients, 64% in normal-weight patients, and 68.9% in those with class III obesity. Increases in DOAC use over time did not differ significantly across the BMI spectrum.; Conclusion: Despite limited safety and efficacy evidence for DOAC use in underweight and obese patients with nonvalvular AF, only modest differences exist in its use and growth over time. These data underscore the importance of future research in underweight and obese patients.; (© 2026 Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research.) |
| Competing Interests: | Dr Al Badarin received honoraria from Pfizer and AstraZeneca. Dr Wimmer received payments for medical legal consulting. Drs Fu and Jones provide statistical analysis for American College of Cardiology. Dr Spertus served as a consultant to Janssen, Imbria, BMS, Terumo, and Ventric Health on PRO Outcomes, unrelated to this work, owns the copyright to the SAQ, KCCQ, and PAQ, and serves on the board of Blue Cross Blue Shield of Kansas City. The other authors report no competing interests. |
| Entry Date(s): | Date Created: 20260501 Date Completed: 20260501 Latest Revision: 20260501 |
| Update Code: | 20260501 |
| PubMed Central ID: | PMC13127389 |
| DOI: | 10.1016/j.mayocpiqo.2025.100692 |
| PMID: | 42064183 |
| Database: | MEDLINE |
Journal Article