Impact de l'obésité morbide sur la mortalité associée à la MTEV.

Background: The influence of morbid obesity on mortality in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated.

Methods: We used the data from RIETE registry to compare the mortality risk during anticoagulation in VTE patients with morbid obesity (body mass index [BMI] ≥40) versus those with normal weight (BMI: 18.5-24.9). Patients with or without active cancer were analyzed separately.

Results: By September 2018, there were 4,443 VTE patients with morbid obesity and 12,047 with normal weight in RIETE. Of these, 245 (5.5%) and 1,397 (11.6%) respectively had cancer. Median duration of anticoagulant therapy was longer in the morbidly obese, with- (185 vs. 114 days) or without cancer (203 vs. 177 days). Among cancer patients, 44 (18.0%) morbidly obese and 1,377 (32.8%) patients with normal weight died during anticoagulation. Among those without cancer, 44 (3.1%) and 601 (5.6%) respectively died. On bivariate analysis, morbid obesity was associated with a lower mortality rate, both in patients with cancer (hazard ratio [HR]: 0.34; 95%CI: 0.25-0.45) and in those without cancer (HR: 0.43; 95%CI: 0.32-0.58). Multivariable analysis confirmed a lower hazard of death in morbidly obese patients with- (HR: 0.68; 95%CI: 0.50-0.94) or without cancer (HR: 0.67; 95%CI: 0.49-0.96). The risk for VTE recurrences or major bleeding did not differ in patients with or without morbid obesity.

Conclusions: In patients with VTE, the risk for death during anticoagulation was about one third lower in morbidly obese patients than in those with normal weight, independently of the presence of cancer.