Renal impairment and lower body weight were both found to be significant predictors of bleeding events in patients with atrial fibrillation (AF) being treated with direct oral anticoagulants (DOACs), according to findings published in the Annals of Pharmacotherapy.

To determine whether body weight and renal function changes impact the rate of adverse effects in AF patients taking DOACs, the researchers conducted a retrospective cohort study that included adults with nonvalvular atrial fibrillation (NVAF) or atrial flutter (AFL) who received a DOAC for at least 1 year. The primary endpoint was a composite of major and clinically relevant nonmajor (CRNM) bleeding events; secondary endpoints included ischemic stroke and bleed event risk factors.

The authors reported that 25 of the total 233 patients included in the study experienced a bleeding event. Patients who had a bleeding event weighed less (10kg less on average; P =.043) and had a higher HAS-BLED score (P =.003), which is used to estimate bleeding risk in AF patients. Multivariate logistic regression determined that significant predictors of bleeding events included weight (P =.048), serum creatinine (SCr; P =.027), as well as HASBLED score (P =.024). The authors also reported that 3 patients in the study had a stroke.

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“These findings add to prescribing considerations for DOACs when initiating a patient’s anticoagulant for AF,” the study authors concluded. They added, “Closer monitoring is advised when prescribing DOACs to non–end-stage renal disease patients with significant renal dysfunction and/or normal to low body weight, even with renal dose adjustments.”


Whittemore H, Posen AK, Hellenbart EL, Groo V, Wenzler E, Tilton JJ. The impact of body weight and renal function on the risk of bleeding with direct oral anticoagulants. Ann. Pharmacother. 2021; doi:10.1177/  

This article originally appeared on MPR