Log in to MyACC
Oral Anticoagulants and Diabetes-Related Complications
Quick Takes
- This nationwide retrospective cohort study reports that patients with AF and DM and without end-stage renal disease receiving NOACs had lower hazards of developing diabetes complications and mortality than those receiving warfarin.
- Furthermore, the sensitivity analyses that applied on-treatment analysis or were limited to those with a high medication possession ratio also supported these findings.
- These data suggest that NOACs may be a better therapeutic choice than warfarin for decreasing complications and mortality in patients with AF and DM requiring oral anticoagulant treatment.
Study Questions:
What are the hazards of diabetes complications and mortality between patients with atrial fibrillation (AF) and diabetes mellitus (DM) receiving non–vitamin K antagonist oral anticoagulants (NOACs) and those receiving warfarin?
Methods:
The investigators conducted a retrospective cohort study using nationwide data obtained from Taiwan’s National Health Insurance Research Database. Patients with AF and DM receiving NOACs or warfarin between 2012–2017 in Taiwan were enrolled. Treatment groups were determined by patients’ first initiation of oral anticoagulants. Hazards of diabetes complications (macrovascular complications, microvascular complications, and glycemic emergency) and mortality in the NOAC and warfarin users were investigated with a target trial design. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HRs). Propensity score methods with stabilized inverse probability of treatment weighting were applied to balance potential confounders between treatment groups.
Results:
In total, 19,909 NOAC users and 10,300 warfarin users were included. Patients receiving NOACs had significantly lower hazards of developing macrovascular complications (HR, 0.84; 95% confidence interval [CI], 0.78-0.91; p < 0.001), microvascular complications (HR, 0.79; 95% CI, 0.73-0.85; p < 0.001), glycemic emergency (HR, 0.91; 95% CI, 0.83-0.99; p = 0.043), and mortality (HR, 0.78; 95% CI, 0.75-0.82; p < 0.001) than those receiving warfarin. Analyses with propensity score matching showed similar results. Several sensitivity analyses further supported the robustness of these findings.
Conclusions:
The authors concluded that NOACs were associated with lower hazards of diabetes complications and mortality than warfarin in patients with AF and DM.
Perspective:
This nationwide retrospective cohort study reports that patients with AF and DM and without end-stage renal disease receiving NOACs had lower hazards of developing diabetes complications and mortality than those receiving warfarin. Furthermore, the sensitivity analyses that applied on-treatment analysis or were limited to those with a high medication possession ratio also supported these findings. These data suggest that NOACs may be a better therapeutic choice than warfarin for decreasing complications and mortality in patients with AF and DM requiring oral anticoagulant treatment. The current study included mostly old and sick patients and whether the study findings apply to a younger, less sick population needs to be tested in future prospective studies and randomized controlled trials.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Diabetes Complications, Diabetes Mellitus, Glycemic Index, Kidney Failure, Chronic, Metabolic Syndrome, National Health Programs, Secondary Prevention, Warfarin, Vascular Diseases, Vitamin K
< Back to Listings
