Evidence map›Paper›PMID 38264923›Full record

SynthesisCirculation2024

Efficacy and Safety of Non-Vitamin-K Antagonist Oral Anticoagulants Versus Warfarin Across the Spectrum of Body Mass Index and Body Weight: An Individual Patient Data Meta-Analysis of 4 Randomized Clinical Trials of Patients With Atrial Fibrillation.

Siddharth M Patel, Eugene Braunwald, Jan Steffel, Giuseppe Boriani, Michael G Palazzolo, Elliott M Antman, Erin A Bohula, Anthony P Carnicelli, Stuart J Connolly, John W Eikelboom and 8 more

Open access · greenAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Circulation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
10.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Observational
  6. Obesity and Atrial Fibrillation: A Comprehensive Review.Methodist DeBakey cardiovascular journal · 2025
    Review
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 8 institutions in 5 countries.

Siddharth M PatelCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0002-4637-4361
Eugene BraunwaldCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0002-3472-626X
Jan SteffelHirslanden Clinic, Zurich, Switzerland and University of Zurich, Switzerland (J.S.).ORCID 0000-0002-1477-9153
Giuseppe BorianiCardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy (G.B.).ORCID 0000-0002-9820-4815
Michael G PalazzoloCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0002-2128-6752
Elliott M AntmanCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0002-0808-9199
Erin A BohulaCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0002-5559-8172
Anthony P CarnicelliCardiology Division, Department of Internal Medicine, Medical University of South Carolina, Charleston (A.P.C.).ORCID 0000-0002-9805-4562
Stuart J ConnollyDepartment of Medicine, McMaster University, Hamilton, Canada (S.J.C., J.W.E.).ORCID 0000-0002-7377-335X
John W EikelboomDepartment of Medicine, McMaster University, Hamilton, Canada (S.J.C., J.W.E.).ORCID 0000-0003-4126-1285
Baris GencerDivision of Cardiology, Geneva University Hospitals, Switzerland (B.G.).ORCID 0000-0002-8954-9694
Christopher B GrangerDuke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC (C.B.G., M.R.P.).ORCID 0000-0002-0045-3291
David A MorrowCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0002-9589-5382
Manesh R PatelDuke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC (C.B.G., M.R.P.).ORCID 0000-0002-2393-0855
Lars WallentinUppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Sweden (L.W.).ORCID 0000-0003-0378-6531
Christian T RuffCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0002-4712-3206
Robert P GiuglianoCardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.).ORCID 0000-0003-4110-7675
COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) Investigators
Brigham and Women's Hospital · USClinical Research Institute · USMcMaster University · CABern University of Applied Sciences · CHKlinik Hirslanden · CHMedical University of South Carolina · USUniversity of Modena and Reggio Emilia · ITUppsala University · SE

Funding

TRAINING PROGRAM IN CARDIOVASCULAR RESEARCHT32HL007604 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI MARK W FEINBERG · 1985 to 2026
$19.0M
NHLBI NIH HHS T32 HL007604
6 · The paper itself

Abstract

backgroundThe efficacy and safety of non-vitamin-K antagonist oral anticoagulants (NOACs) across the spectrum of body mass index (BMI) and body weight (BW) remain uncertain.

methodsWe analyzed data from COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation), which pooled patient-level data from the 4 pivotal randomized trials of NOAC versus warfarin in patients with atrial fibrillation. The primary efficacy and safety outcomes were stroke or systemic embolic events (stroke/SEE) and major bleeding, respectively; secondary outcomes were ischemic stroke/SEE, intracranial hemorrhage, death, and the net clinical outcome (stroke/SEE, major bleeding, or death). Each outcome was examined across BMI and BW. Because few patients had a BMI <18.5 kg/m

resultsAmong 58 464 patients, the median BMI was 28.3 (interquartile range, 25.2-32.2) kg/m

conclusionsThe treatment effect of NOACs versus warfarin in atrial fibrillation is generally consistent for stroke/SEE across the spectrum of BMI and BW, whereas the reduction in major bleeding is attenuated in those with higher BMI or BW. Death and the net clinical outcome are overall reduced with NOACs over warfarin, although there remain uncertainties for these outcomes at a very high BMI and BW.

Indexed as

Atrial FibrillationStrokeAdministration, OralAnticoagulantsBody Mass IndexBody WeightHemorrhageHumansRandomized Controlled Trials as TopicTreatment OutcomeWarfarinAnticoagulantsWarfarinanticoagulationatrial fibrillationclinical trialmeta-analysisobesitystrokewarfarin

Identifiers

PMID38264923
PMCPMC12560831
OpenAlexW4391173849

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.