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September 8, 2026Journal of Thrombosis and ThrombolysisOpen Access

Dabigatran use and cerebrovascular event risk across body mass index in atrial fibrillation: a real-world nested case–control study

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Why the study?

Does dabigatran use reduce incident ischaemic stroke or transient ischaemic attack in patients with atrial fibrillation across different BMI categories?

Population

1,854 patients with atrial fibrillation in a multiethnic New Zealand population.

Comparison

Dabigatran use vs No dabigatran use

Design

Case-control

Key result

Dabigatran use was associated with a 50% lower odds of ischemic stroke or transient ischemic attack compared to no oral anticoagulant in patients with atrial fibrillation (aOR 0.50).

Authors

KMKarim MahawishVFValery L. FeiginPBP. Alan Barber

Discussion

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Overview

Dabigatran was associated with lower IS/TIA odds across BMI; leaves open efficacy in class III obesity pending randomized data.

Key Points

  • To evaluate the association between dabigatran use and ischaemic stroke or transient ischaemic attack across body mass index categories in patients with atrial fibrillation.
  • Conducted a retrospective nested case–control study of 1,854 patients with atrial fibrillation (295 incident ischaemic stroke/TIA cases from the Auckland Regional Community Stroke Study and 1,559 controls from the National Minimum Dataset).
  • Evaluated dabigatran exposure and assessed effect modification across BMI tiers (<30, 30–39.9, and ≥40 kg/m²) using multivariable logistic regression interaction terms.
  • Dabigatran use overall was associated with significantly reduced odds of ischaemic stroke or TIA (aOR 0.50, 95% CI 0.38–0.68).
  • Effect modification by BMI category was not statistically significant (p-interaction = 0.49), showing similar risk reductions in patients with BMI <30 and 30–39.9 kg/m².
  • In Class III obesity (BMI ≥40 kg/m²), the point estimate shifted toward the null and was imprecise, meaning clinically important attenuation could not be excluded.

Study Design

Type

Case-Control (n=1,854)

Multicenter

Yes

Structured PICO

Does dabigatran use reduce incident ischaemic stroke or transient ischaemic attack in patients with atrial fibrillation across different BMI categories?

P
Population
1,854 adult patients with atrial fibrillation, including 295 with incident ischemic stroke or TIA and 1,559 event-free controls, evaluated for the association between dabigatran use and cerebrovascular events across BMI categories.
E
Exposure
Dabigatran use
C
Comparator
No dabigatran use
O
Outcome
Incident ischaemic stroke (IS) or transient ischaemic attack (TIA)hard clinical

Main Result

Odds Ratio: 0.5 (95% CI 0.38–0.68)

p-value: p=<0.001

Dabigatran use is associated with a 50% reduction in the odds of ischemic stroke or TIA in patients with atrial fibrillation, with no significant effect modification by BMI, although efficacy in Class III obesity remains uncertain.

Limitations

  • Case-control design precludes causal inference and residual confounding cannot be excluded.
  • Adherence derived from dispensing data may not fully reflect actual medication use.
  • Limited statistical power in patients with Class III obesity (BMI ≥40 kg/m2) due to small sample size.
  • BMI does not fully capture adiposity or fat distribution and may misclassify risk across ethnic groups.
  • Use of non-anticoagulated patients as the reference group may introduce confounding by indication and healthy-user or frailty-related bias.
  • Could not distinguish new users from prevalent users due to lack of historical dispensing data.
  • Limited power in patients with BMI ≥40 kg/m2
  • Clinically important attenuation in Class III obesity could not be excluded

Cite This Study

Mahawish et al. (2026) conducted a case-control in Atrial fibrillation (n=1,854). Dabigatran vs. No oral anticoagulant was evaluated on Ischaemic stroke or transient ischaemic attack (IS/TIA) (aOR 0.50, 95% CI 0.38-0.68, p=<0.001). Dabigatran use was associated with a 50% lower odds of ischemic stroke or transient ischemic attack compared to no oral anticoagulant in patients with atrial fibrillation (aOR 0.50).

synapsesocial.com/papers/6a9fd82058e84d0ff5b47698https://doi.org/10.1007/s11239-026-03394-1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Impact of weight/BMI on clinical and bleeding events in 26 805 atrial fibrillation patients on edoxaban from the Global ETNA-AF Registry2025
  2. 2Ablation outcome and post-interventional management of anticoagulation in patients with obesity or severe obesity and atrial fibrillation2026
  3. 3Evaluating the effect of morbid obesity on DVT in patients already on doac therapy: A retrospective analysis2025
  4. 4Achieving BMI &lt;25 kg/m2 was associated with reduced predicted risk of atherosclerotic cardiovascular disease in people with obesity or overweight on tirzepatide or placebo: a post hoc analysis of SURMOUNT-1, -3, and -CN2025
  5. 5Impact of renal impairment and other high bleeding risk factors on clinical outcomes among Asian patients with atrial fibrillation on edoxaban: a post hoc analysis of the ETNA-AF program2026