Compared with warfarin, apixaban (HR 0.67; 95% CI 0.57-0.77) and rivaroxaban (HR 0.79; 95% CI 0.71-0.89) were associated with a lower risk of stroke or systemic embolism in NVAF and diabetes.
Observational (n=154,324)
Yes
Do NOACs (apixaban, dabigatran, rivaroxaban) reduce stroke/systemic embolism and major bleeding compared to warfarin in patients with nonvalvular atrial fibrillation and diabetes?
In patients with NVAF and diabetes, apixaban and rivaroxaban were associated with lower stroke/SE risk than warfarin, while apixaban and dabigatran were associated with lower major bleeding risk.
Hazard Ratio: 0.67 (95% CI 0.57–0.77)
OBJECTIVE: To address gaps in the data comparing non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin among patients with nonvalvular atrial fibrillation (NVAF) and diabetes. PATIENTS AND METHODS: A retrospective study was conducted on patients with NVAF and diabetes newly initiating apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with Medicare data from the US Centers for Medicare 95% CI, 0.57-0.77) and rivaroxaban (HR, 0.79; 95% CI, 0.71-0.89) were associated with a lower risk of stroke/SE; dabigatran (HR, 0.84; 95% CI, 0.67-1.07) was associated with a similar risk of stroke/SE. Apixaban (HR, 0.60; 95% CI, 0.56-0.65) and dabigatran (HR, 0.78; 95% CI, 0.69-0.88) were associated with a lower risk of MB; rivaroxaban (HR, 1.02; 95% CI, 0.94-1.10) was associated with a similar risk of MB compared with warfarin. Compared with dabigatran and rivaroxaban, apixaban was associated with a lower risk of MB. Compared with rivaroxaban, dabigatran was associated with a lower risk of MB. CONCLUSION: This study-the largest observational study to date of patients with NVAF and diabetes taking anticoagulants-found that NOACs were associated with variable rates of stroke/SE and MB compared with warfarin. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03087487.
Lip et al. (Fri,) conducted a observational in Nonvalvular atrial fibrillation and diabetes mellitus (n=154,324). NOACs (apixaban, dabigatran, rivaroxaban) vs. Warfarin was evaluated on Stroke/systemic embolism (SE) (HR 0.67, 95% CI 0.57-0.77). Compared with warfarin, apixaban (HR 0.67; 95% CI 0.57-0.77) and rivaroxaban (HR 0.79; 95% CI 0.71-0.89) were associated with a lower risk of stroke or systemic embolism in NVAF and diabetes.