Effectiveness, safety, and major adverse limb events in atrial fibrillation patients with concomitant diabetes mellitus treated with non-vitamin K antagonist oral anticoagulants

BACKGROUND: Evidence of adverse clinical outcomes for non-vitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation (AF) and diabetes mellitus are limited. We investigated the effectiveness, safety, and major adverse limb events for NOACs versus warfarin among diabetic AF patients.

METHODS: In this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, we identified a total of 20,967 and 5812 consecutive AF patients with diabetes taking NOACs and warfarin from June 1, 2012, to December 31, 2017, respectively. We used propensity-score stabilized weighting to balance covariates across study groups.

RESULTS: NOAC was associated with a lower risk of major adverse cardiovascular events (MACE) (adjusted hazard ratio (aHR):0.88; [95% confidential interval (CI) 0.78-0.99]; P = 0.0283), major adverse limb events (MALE) (aHR:0.72;[95% CI 0.57-0.92]; P = 0.0083), and major bleeding (aHR:0.67;[95% CI 0.59-0.76]; P < 0.0001) compared to warfarin. NOACs decreased MACE in patients of ≥ 75 but not in those aged < 75 years (P interaction = 0.01), and in patients with ischemic heart disease (IHD) compared to those without IHD (P interaction < 0.01). For major adverse limb events, the advantage of risk reduction for NOAC over warfarin persisted in high risk subgroups including age ≥ 75 years, chronic kidney disease, IHD, peripheral artery disease, or use of concomitant antiplatelet drugs.

CONCLUSION: Among diabetic AF patients, NOACs were associated with a lower risk of thromboembolism, major bleeding, and major adverse limb events than warfarin. Thromboprophylaxis with NOACs should be considered in the diabetic AF population with a high atherosclerotic burden.

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:19

Enthalten in:

Cardiovascular diabetology - 19(2020), 1 vom: 13. Mai, Seite 63

Sprache:

Englisch

Beteiligte Personen:

Chan, Yi-Hsin [VerfasserIn]
Lee, Hsin-Fu [VerfasserIn]
Li, Pei-Ru [VerfasserIn]
Liu, Jia-Rou [VerfasserIn]
Chao, Tze-Fan [VerfasserIn]
Wu, Lung-Sheng [VerfasserIn]
Chang, Shang-Hung [VerfasserIn]
Yeh, Yung-Hsin [VerfasserIn]
Kuo, Chi-Tai [VerfasserIn]
See, Lai-Chu [VerfasserIn]
Lip, Gregory Y H [VerfasserIn]

Links:

Volltext

Themen:

5Q7ZVV76EI
Anticoagulants
Atrial fibrillation
Comparative Study
Diabetes mellitus
Factor Xa Inhibitors
Ischemic stroke
Journal Article
Major bleeding
NOACs
Research Support, Non-U.S. Gov't
Warfarin

Anmerkungen:

Date Completed 26.10.2020

Date Revised 07.12.2022

published: Electronic

Citation Status MEDLINE

doi:

10.1186/s12933-020-01043-2

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM309871336