A real-world exploration into clinical outcomes of direct oral anticoagulant (DOAC) dosing regimens in morbidly obese patients using data-driven approaches

Ezekwesiri Nwanosike, Wendy Sunter, Muhammad Ayub Ansari, Hamid Merchant, Barbara Conway, Syed Shahzad Hasan

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction
The clinical outcomes of direct oral anticoagulant (DOACs) dosage regimens in morbid obesity are uncertain due to limited clinical evidence. This study seeks to bridge this evidence gap by identifying the factors associated with clinical outcomes following the dosing of DOACs in morbidly obese patients.
Method
A data-driven observational study was carried out using supervised machine learning (ML) models with a dataset extracted from electronic health records and pre-processed. Following 70%:30% partitioning of the overall dataset via stratified sampling, the selected ML classifiers (e.g., random forest, decision trees, bootstrap aggregation) were applied to the training dataset (70%). The outcomes of the models were evaluated against the test dataset (30%). Multivariate regression analysis explored the association between DOAC regimens and clinical outcomes.
Results
A sample of 4,275 morbidly obese patients was extracted and analysed. The decision trees, random forest, and bootstrap aggregation classifiers achieved acceptable (excellent) values of precision, recall, and F1 scores in terms of their contribution to clinical outcomes. The length of stay, treatment days, and age were ranked highest for relevance to mortality and stroke. Among DOACs regimens, apixaban 2.5mg BD ranked highest for its association with mortality, increasing the mortality risk by 43% (OR 1.430, 95% CI: 1.181, 1.732, p=0.001). On the other hand, Apixaban 5mg BD reduced the odds of mortality by 25% (OR 0.751, 95% CI: 0.632, 0.905, p=0.003) but increased the odds of stroke events. No clinically relevant non-major bleeding events occurred in this group.
Conclusion
Data-driven approaches can identify key factors associated with clinical outcomes following the dosing of DOACs in morbidly obese patients. This will help design further studies to explore safe and effective DOAC doses for morbidly obese patients.
Key Points
• Data-driven analysis of electronic health records using machine learning and multivariate
regression model provided valuable insights into DOAC dosages in morbidly obese patients
• The decision tree and random forest accurately identified factors contributing to the clinical
outcomes in morbidly obese patients receiving DOACs.
• Apixaban 2.5mg BD regimen increased the mortality risk by 43% in morbidly obese patients.
Conversely, Apixaban 5mg BD regimen reduced the odds of mortality by 25% but increased
the odds of stroke events.
Original languageEnglish
JournalAmerican Journal of Cardiovascular Drugs
Publication statusAccepted/In press - 27 Dec 2022

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