NOACs better than warfarin in diabetic patients with atrial fibrillation

Treatment with nonvitamin K antagonist oral anticoagulants (NOACs) results in lower risks of diabetes complications and mortality compared with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus (DM), suggest a study.

This retrospective cohort study used nationwide data obtained from Taiwan’s National Health Insurance Research Database. The authors enrolled patients with AF and DM on NOACs or warfarin between 2012 and 2017. They determined treatment groups by patients’ first initiation of oral anticoagulants.

A target trial design was employed to assess the hazards of diabetes complications (eg, macrovascular complications, microvascular complications, and glycaemic emergency) and mortality among NOAC and warfarin users. The authors estimated hazard ratios (HRs) using cause-specific Cox proportional hazards models and balanced potential confounders between groups using propensity score methods with stabilized inverse probability of treatment weighting.

Of the participants included, 19,909 were NOAC users and 10,300 were warfarin users. Patients on NOACs had significantly lower risks of developing macrovascular complications (HR, 0.84, 95 percent confidence interval [CI], 0.78‒0.91; p<0.001), microvascular complications (HR, 0.79, 95 percent CI, 0.73‒0.85; p<0.001), glycaemic emergency (HR, 0.91, 95 percent CI, 0.83‒0.99; p=0.043), and mortality (HR, 0.78, 95 percent CI, 0.75‒0.82; p<0.001) than those receiving warfarin.

Results were consistent after propensity score matching, and several sensitivity analyses further supported the strength of these findings.

However, “[t]he claims-based data did not allow for detailed data on patients' lifestyles and laboratory examinations to be obtained,” the authors said.