Effectiveness and Safety of Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation and Diabetes Mellitus

Abstract

Objective: To address gaps in the data comparing nonevitamin K antagonist oral anticoagulants (NOACs) and warfarin among patients with nonvalvular atrial fibrillation (NVAF) and diabetes. Patients and Methods: A retrospective study was conducted on patients with NVAF and diabetes newly initiating apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with Medicare data from the US Centers for Medicare & Medicaid Services and 4 other US commercial claims databases. One-to-one propensity score matching was completed between NOACs and warfarin and between NOACs in each database, and the results were pooled. Cox proportional hazards models were used to evaluate the risk of stroke/systemic embolism (SE) and major bleeding (MB). Results: A total of 154,324 patients were included in the 6 matched cohorts, with a mean follow-up time of 6 to 8 months. Compared with warfarin, apixaban (hazard ratio [HR], 0.67; 95% CI, 0.57-0.77) and rivaroxaban (HR, 0.79; 95% CI, 0.71-0.89) were associated with a lower risk of stroke/SE; dabigatran (HR, 0.84; 95% CI, 0.67-1.07) was associated with a similar risk of stroke/SE. Apixaban (HR, 0.60; 95% CI, 0.56-0.65) and dabigatran (HR, 0.78; 95% CI, 0.69-0.88) were associated with a lower risk of MB; rivaroxaban (HR, 1.02; 95% CI, 0.94-1.10) was associated with a similar risk of MB compared with warfarin. Compared with dabigatran and rivaroxaban, apixaban was associated with a lower risk of MB. Compared with rivaroxaban, dabigatran was associated with a lower risk of MB. Conclusion: This studydthe largest observational study to date of patients with NVAF and diabetes taking anticoagulantsdfound that NOACs were associated with variable rates of stroke/SE and MB compared with warfarin. Trial Registration: clinicaltrials.gov Identifier: NCT03087487

Comparative effectiveness and safety of direct oral anticoagulants versus warfarin in UK patients with atrial fibrillation and type 2 diabetes: A retrospective cohort study

“…In the ARISTOTLE trial comparing apixaban and warfarin, diabetes was independently associated with an increased risk of bleeding events, and the reduction in bleeding with apixaban appeared to be less in diabetic patients compared with non‐diabetics 11 . In the study by Lip et al, the risk of major bleeding was significantly lower in apixaban users compared to warfarin among patients with AF and diabetes 36 …”

“…Our findings of similar risks of stroke in patients taking apixaban or rivaroxaban compared to warfarin are not in line with a large observational study in patients with AF and diabetes by Lip et al, were apixaban and rivaroxaban were associated with a lower risk of stroke compared to warfarin. 36 …”

“…11 In the study by Lip et al, the risk of major bleeding was significantly lower in apixaban users compared to warfarin among patients with AF and diabetes. 36 …”

The impact of diabetes and osteoarthritis on the occurrence of stroke, acute myocardial infarction, and heart failure among older adults with non-valvular atrial fibrillation in Hawaii: a retrospective observational cohort study

“…The observed disparities could be related to the adherence level to the complex medical advice for NVAF management. For example, clinical cares for patients with NVAF often include oral anticoagulants to prevent blood clotting and manage blood flow to prevent further clinical complications [ 41 ]. However, suboptimal adherence to anticoagulants is common among patients with NVAF due to the necessity of routine monitoring for prothrombin time and special attention to avoid drug-drug and drug-food interactions [ 42 ].…”

Cardiovascular risks and bleeding with non-vitamin K antagonist oral anticoagulant versus warfarin in patients with type 2 diabetes: a tapered matching cohort study

“…Previous trials [22][23][24][25][26][27][28][29] and two meta-analysis [30,31] revealed non-difference or benefits of NOAC for diabetes patients with AF. This differs from our target population which was the general type 2 diabetes population.…”