Diabetes complications less likely in non-vitamin K antagonist oral anticoagulant users
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Adults with atrial fibrillation and diabetes who received non-vitamin K antagonist oral anticoagulants had a lower risk for diabetes complications and mortality than those who received warfarin, a retrospective cohort study showed.
Atrial fibrillation is the “most common and clinically significant cardiac arrhythmia,” and diabetes is “one of the most common chronic medical conditions,” Huei-Kai Huang, MD, of the Institute of Epidemiology and Preventive Medicine at the College of Public Health at National Taiwan University, and colleagues wrote in Annals of Internal Medicine. Individuals with diabetes are at risk for irregular heartbeats, they added.
“Real-world population-based studies have suggested that [non-vitamin K antagonist oral anticoagulants (NOACs)] are associated with a lower risk for incident diabetes than warfarin in patients with [atrial fibrillation] and without [diabetes mellitus],” the researchers wrote. “However, the influence of different oral anticoagulants on the risk for diabetes-related complications is not completely understood and is a critical issue in improving prognoses in patients with [atrial fibrillation] and [diabetes mellitus] requiring oral anticoagulant treatment.”
Huang and colleagues analyzed data from Taiwan’s National Health Insurance Research Database on older patients with atrial fibrillation and diabetes mellitus who were prescribed NOACs (n = 19,909) or warfarin (n = 10,300). The patients (mean age, 73.8 years; 45.8% women) were followed from the first day they received a NOAC or warfarin prescription until a corresponding outcome, death or Dec. 31, 2018, whichever came first. The researchers used an “as-started model design (analog of intention to treat)” to emulate a target trial to strengthen causal inference from observational data.”
The researchers reported that the patients who were prescribed NOACs had a significantly lower risk for experiencing macrovascular complications (HR = 0.84; 95% CI, 0.78-0.91), microvascular complications (HR = 0.79; 95% CI, 0.73-0.85), glycemic emergency (HR = 0.91; 95% CI, 0.83-0.99) and death (HR = 0.78; 95 % CI, 0.75-0.82) compared with those who were prescribed warfarin.
“Analyses with propensity score matching showed similar results,” Huang and colleagues wrote. “Several sensitivity analyses further supported the robustness of our findings.”
The researchers also wrote that during a median follow-up period of 2.9 years, 46% of all patients receiving warfarin switched to NOACs, suggesting that “the as-started analysis may have underestimated the difference between NOAC and warfarin use. Nevertheless, such a conservative approach still showed a significantly lower hazard for composite complication outcomes and mortality in NOAC users than in warfarin user.”
According to Huang and colleagues, future studies are needed to assess whether their findings can be replicated among patients who simultaneously take different antidiabetic medications.