Non-vitamin K oral anticoagulants decreased the risk of stroke and systemic embolism and reduced major bleeding compared with warfarin in patients with atrial fibrillation and diabetes.
Do non-vitamin K oral anticoagulants improve efficacy and safety compared to warfarin in people with atrial fibrillation and diabetes mellitus?
The efficacy and safety benefits of NOACs over warfarin in atrial fibrillation extend to patients with concurrent diabetes mellitus.
AIMS: To examine the efficacy and safety of non-vitamin K oral anticoagulants in people with both atrial fibrillation and diabetes mellitus. METHODS: We reviewed efficacy and safety data from the warfarin-controlled phase III non-vitamin K oral anticoagulants trials (ARISTOTLE, RE-LY, ROCKET-AF, ENGAGE AF-TIMI 48) and their post hoc analyses with regard to diabetes status. We also reviewed the updated literature regarding this population. RESULTS: At baseline 20-40% of the participants in the phase III non-vitamin K oral anticoagulants trials had diabetes mellitus at baseline. This population, in comparison with those without diabetes, was more likely to have other comorbidities, such as hypertension and coronary artery disease; thus, their cardiovascular risk was higher. Participants with diabetes had higher rates of stroke and systemic embolism than participants without diabetes. This risk was decreased using non-vitamin K oral anticoagulants, with no significant interaction by diabetic status or the specific drug used. Overall, compared with warfarin, non-vitamin K oral anticoagulants were safe and reduced the incidence of major bleeding in people with atrial fibrillation and diabetes, although the results varied with the different non-vitamin K oral anticoagulants. CONCLUSIONS: The efficacy and safety of non-vitamin K oral anticoagulants compared with warfarin generally extend to participants with diabetes mellitus, although dedicated randomized trials or real-world data are lacking.
Zadok et al. (Tue,) conducted a review in Atrial fibrillation and diabetes mellitus. Non-vitamin K oral anticoagulants vs. Warfarin was evaluated on Stroke, systemic embolism, and major bleeding. Non-vitamin K oral anticoagulants decreased the risk of stroke and systemic embolism and reduced major bleeding compared with warfarin in patients with atrial fibrillation and diabetes.