• Huei-Kai Huang, Peter Pin-Sung Liu, Shu-Man Lin, Jin-Yi Hsu, Jih-I Yeh, Edward Chia-Cheng Lai, Carol Chiung-Hui Peng, Kashif M Munir, Ching-Hui Loh, and Yu-Kang Tu.
• Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, and Department of Family Medicine and Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (H.K.H.).
• Ann. Intern. Med. 2022 Apr 1; 175 (4): 490-498.

BackgroundEvidence about the association between types of oral anticoagulants and hazards of diabetes complications is limited in patients with atrial fibrillation (AF) and diabetes mellitus (DM).ObjectiveTo compare the hazards of diabetes complications and mortality between patients with AF and DM receiving non-vitamin K antagonist oral anticoagulants (NOACs) and those receiving warfarin.DesignA retrospective cohort study.SettingNationwide data obtained from Taiwan's National Health Insurance Research Database.PatientsPatients with AF and DM receiving NOACs or warfarin between 2012 and 2017 in Taiwan were enrolled. Treatment groups were determined by patients' first initiation of oral anticoagulants.MeasurementsHazards of diabetes complications (macrovascular complications, microvascular complications, and glycemic emergency) and mortality in the NOAC and warfarin users were investigated with a target trial design. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HRs). Propensity score methods with stabilized inverse probability of treatment weighting were applied to balance potential confounders between treatment groups.ResultsIn total, 19 909 NOAC users and 10 300 warfarin users were included. Patients receiving NOACs had significantly lower hazards of developing macrovascular complications (HR, 0.84 [95% CI, 0.78 to 0.91]; P < 0.001), microvascular complications (HR, 0.79 [CI, 0.73 to 0.85]; P < 0.001), glycemic emergency (HR, 0.91 [CI, 0.83 to 0.99]; P = 0.043), and mortality (HR, 0.78 [CI, 0.75 to 0.82]; P < 0.001) than those receiving warfarin. Analyses with propensity score matching showed similar results. Several sensitivity analyses further supported the robustness of our findings.LimitationThe claims-based data did not allow for detailed data on patients' lifestyles and laboratory examinations to be obtained.ConclusionNon-vitamin K antagonist oral anticoagulants were associated with lower hazards of diabetes complications and mortality than warfarin in patients with AF and DM.Primary Funding SourceHualien Tzu Chi Hospital.

33 keywords...

hide…