Non–vitamin K antagonist oral anticoagulants (NOACs) are associated with lower hazards of diabetes complications and mortality compared with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus (DM), according to a study in the Annals of Internal Medicine.

The nationwide retrospective cohort study was based on data from Taiwan’s National Health Insurance Research Database (NHIRD) and included adult patients aged ≥20 years who were diagnosed with AF and DM and who had received oral anticoagulants between 2012 and 2017.

The participants were categorized into NOAC and warfarin groups according to their first prescription of oral anticoagulant type. The 4 primary outcomes were macrovascular complications, microvascular complications, glycemic emergency, and all-cause mortality.


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The initial study population included 19,909 NOAC users and 10,300 warfarin users after stabilized inverse probability of treatment weighting (IPTW). For the propensity score–matching analysis, 7677 patients were included in the NOAC and the warfarin groups. Participants’ overall mean age was 73.8 years, 45.8% were female, and the overall mean follow-up was 2.9 years.

In the analyses with stabilized IPTW, patients who used NOACs had significantly lower hazard ratios of macrovascular complications (hazard ratio [HR], 0.84 [95% CI, 0.78-0.91]; P < 0.001), microvascular complications (HR, 0.79 [CI, 0.73-0.85]; P < .001), glycemic emergency (HR, 0.91 [CI, 0.83-0.99]; P = .043), and mortality (HR, 0.78 [CI, 0.75-0.82]; P < .001) compared with warfarin users.

Sensitivity analysis involving on-treatment design also revealed significantly lower hazard ratios of macrovascular complications (HR, 0.83 [CI, 0.75-0.92]; P < .001), microvascular complications (HR, 0.68 [CI, 0.61-0.75]; P < .001), glycemic emergency (HR, 0.81 [CI, 0.71-0.93]; P = .003), and mortality (HR, 0.63 [CI, 0.59-.68]; P < .001) for NOAC users compared with warfarin users.

Study limitations include the absence of data on patients’ lifestyle, substance use, body mass index, and detailed laboratory results. Also, the investigators could not assess or adjust for the influence of potential subtherapeutic international normalized ratios on stroke and mortality hazard in warfarin users. Furthermore, the study population primarily included older people and people who were consider in poor health as defined by the study researchers and the NHIRD in Taiwan.

“This nationwide retrospective cohort study showed that, compared with warfarin use, NOAC use was associated with lower hazards of diabetes-related complications and mortality among patients with AF and DM and without end-stage renal disease,” concluded the study authors. “Therefore, NOACs may be a better therapeutic choice than warfarin for decreasing these complications and mortality in patients with AF and DM requiring oral anticoagulant treatment.”

Disclosure: At least one study author declared affiliation with private industry. Please see the original reference for a full list of disclosures.

Reference

Huang H-K, Liu PP-S, Lin S-M, et al. Diabetes-related complications and mortality in patients with atrial fibrillation receiving different oral anticoagulants: a nationwide analysis. Ann Intern Med. Published online February 15, 2022. doi:10.7326/M21-3498