Key result
OACs and antidiabetic drugs show no major hazard, but warfarin plus sulfonylureas is linked to hypoglycemia.
Why the study?
To evaluate the safety and adverse outcome risks of concomitant use of oral anticoagulants and antidiabetic drugs across observational studies.
Does concomitant use of oral anticoagulants and antidiabetic drugs increase the risk of adverse outcomes such as hypoglycemia or bleeding?
Systematic Review (n=1,370,036)
Does concomitant use of oral anticoagulants and antidiabetic drugs increase the risk of adverse outcomes such as hypoglycemia or bleeding?
This systematic review suggests no major clinical hazards from the concomitant use of oral anticoagulants and antidiabetic drugs, though evidence is limited by inconsistency and risk of bias.
INTRODUCTION: We systematically reviewed observational studies assessing the safety of concomitant use of oral anticoagulants (OACs) and antidiabetic drugs (ADs). METHODS: We systematically searched MEDLINE/PubMed and EMBASE up to 10/2024 for cohort, case-control, and case-only studies on concomitant use of OACs and ADs and the risk of adverse outcomes (hypoglycemia, bleeding). Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Concomitant use of sulfonylureas and warfarin was mostly associated with increased risks of hypoglycemia versus sulfonylurea use alone (five studies); results were heterogeneous when comparing concomitant use of sulfonylureas and warfarin versus concomitant use of sulfonylureas and DOACs (two studies) and concomitant use of non-sulfonylurea ADs and warfarin versus non-sulfonylurea AD use alone (two studies). Concomitant use of warfarin and sulfonylureas was not associated with the risk of bleeding versus warfarin use alone (one study). Via ROBINS-I, four studies were at moderate, one at serious, and two at critical risk of bias. CONCLUSIONS: Given inconsistent findings and a non-negligible risk of bias, observational studies do not suggest major clinical hazards due to concomitant use of OACs and ADs. (PROSPERO registration: CRD42024505475).
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Tassopoulou et al. (2025) conducted a systematic review in Patients using oral anticoagulants and antidiabetic drugs (n=1,370,036). Concomitant use of oral anticoagulants and antidiabetic drugs vs. Use of oral anticoagulants or antidiabetic drugs alone was evaluated on Adverse outcomes (hypoglycemia, bleeding). Concomitant use of oral anticoagulants and antidiabetic drugs does not suggest major clinical hazards, though sulfonylureas and warfarin were associated with increased hypoglycemia risk.
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