Use of direct oral anticoagulants for acute pulmonary embolisms in obesity: a propensity-matched, multicentre case–control study

Chinthaka B. Samaranayake; Gregory Keir; Simon A.A. Slader; Tommy Tseng; Khoa Tran; James Anderson; Andrew McCann; Colm McCabe; John W. Upham

doi:10.1183/23120541.00379-2021

Tables

TABLE 1

Baseline characteristics and outcomes of study participants

Characteristics	DOAC^#	Warfarin^¶	p-value
Baseline characteristics
Demographics
Age years, median (interquartile range)	60.1 (36.2–84.1)	59.0 (35.4–82.3)	0.83
Female, n (%)	83 (53.9)	41 (53.2)	0.92
Anthropometrics
Height cm, mean±sd	170.9±9.3	170.8±9.0	0.91
Weight kg, mean±sd	122.4±22.6	125.9±33.5	0.82
BMI kg·m⁻², mean±sd	42.0±7.5	43.3±11.8	0.74
BMI >40 kg·m⁻² or weight >120 kg, n (%)	104 (67.5)	46 (59.7)	0.24
Clinical parameters on presentation
First recorded SBP mmHg, mean±sd	128.1±21.5	124.5±25.7	0.31
First recorded heart rate, mean±sd	96.5±19.1	96.6±18.1	0.89
S_pO₂ <94% on presentation, n (%)	73 (47.4)	40 (51.9)	0.51
History of malignancy, n (%)	16 (10.4)	6 (7.8)	0.43
PESI score, mean±sd	86.1±29.9	88.7±33.7	0.56
PESI score, n (%)
Class V: very high risk	14 (9.1)	7 (9.1)
Class IV: high risk	19 (12.3)	11 (14.3)	0.24
Class III: moderate risk	49 (31.8)	24 (31.2)	0.89
Class II: low risk	29 (18.8)	15 (19.5)	0.78
Class I: very low risk	43 (27.9)	20 (26.0)	0.67
CTPA characteristics
Most proximal clot location, n (%)
Saddle/main PA	36 (23.4)	13 (16.7)	0.47
Lobar arteries	66 (42.9)	36 (46.8)	0.78
Segmental	25 (32.5)	46 (30.0)	0.81
Clot number: bilateral	133 (86.3)	62 (80.5)	0.50
RHS on CTPA, n (%)	97 (63.3)	51 (66.2)	0.83
Echocardiographic parameters
LV impairment, n (%)	16 (12.7)	7 (11.3)	0.76
RV impairment, n (%)	78 (61.9)	39 (60.0)	0.89
RV dilatation, n (%)	92 (73.1)	41 (66.1)	0.46
RVSP mmHg, mean±sd	43.5±12.4	43.9 (10.5)	0.85
Laboratory markers
Elevated troponin, n (%)	72 (62.6)	29 (64.4)	0.88
Lactate on presentation mmol·L⁻¹, mean±sd	2.3±1.4	2.5±1.6	0.52
eGFR mL·min⁻¹·1.73 m⁻², mean±sd	68.1±15.5	67.3±20.2	0.78
Pulmonary embolism risk category
Low risk	39 (25.3)	16 (20.8)	0.45
Intermediate–low risk	45 (29.2)	30 (39.0)	0.14
Intermediate–high risk	57 (37.0)	22 (28.6)	0.24
High risk	13 (8.4)	9 (11.7)	0.48
Initial treatment
Intravenous heparin infusion, n (%)	66 (42.9)	40 (51.9)	0.11
Low molecular-weight heparin, n (%)	53 (34.4)	28 (36.4)	0.69
Thrombolysis and heparin, n (%)	13 (8.4)	9 (11.7)	0.62
Upfront DOAC	22 (14.3)
Type of DOAC and maintenance dose
Rivaroxaban 20 mg daily, n (%)	141 (91.6)
Apixaban 5 mg twice daily, n (%)	13 (8.4)
Outcomes at follow-up
Recurrent VTE within 6 months, n (%)
All recurrent VTE, n (%)	9 (5.8)	5 (6.5)	0.85
Recurrent pulmonary embolism, n (%)	4 (2.6)	3 (3.9)	0.59
Bleeding within 6 months
Major bleeding, n (%)	1 (0.6)	2 (2.6)	0.25
CRNM bleeding, n (%)	7 (4.5)	6 (7.8)	0.22
Minor bleeding, n (%)	14 (9.1)	5 (6.5)	0.58
Mortality
30-day all-cause mortality, n (%)	2 (1.3)	3 (3.9)	0.22
6-month all-cause mortality, n (%)	4 (2.6)	5 (6.5)	0.16
Length of hospital stay days, mean±sd	5.1 (3.8)	7.9 (4.1)	0.01

DOAC: direct oral anticoagulant; BMI: body mass index; SBP: systolic blood pressure; S_pO₂: oxygen saturation measured by pulse oximetry; PESI: pulmonary embolism severity index; PA: pulmonary artery; RHS: right heart strain; CTPA: computed tomography pulmonary angiogram; LV: left ventricle; RV: right ventricle; RVSP: right ventricular systolic pressure; VTE: venous thromboembolism; CRNM: clinically relevant non-major. ^#: n=154; ^¶: n=77.