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August 17, 2022Clinical Research in CardiologyOpen Access

Heterogeneity of outcomes within diabetic patients with atrial fibrillation on edoxaban: a sub-analysis from the ETNA-AF Europe registry

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Why the study?

Recent data suggested that insulin-requiring diabetes largely drives the increased thromboembolic risk in AF patients on warfarin, prompting evaluation of how diabetes status impacts clinical outcomes in AF patients treated with edoxaban.

Does diabetes status (insulin-requiring vs non-insulin-requiring) affect the risk of thromboembolic events in patients with atrial fibrillation treated with edoxaban?

Population

13,133 AF patients treated with edoxaban

Comparison

Diabetes on insulin vs diabetes not on insulin vs no diabetes

Design

Prospective, multicenter registry sub-analysis

Follow-up

2 years

Authors

GPGiuseppe PattiLPLadislav PecenGCGiuseppina Casalnuovo

Discussion

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Member takes

Overview

May identify higher thromboembolic risk in insulin-treated diabetic AF on edoxaban; hypothesis-generating and requires prospective validation.

Structured PICO

Does diabetes status (insulin-requiring vs non-insulin-requiring) affect the risk of thromboembolic events in patients with atrial fibrillation treated with edoxaban?

P
Population
13,133 adults with atrial fibrillation treated with edoxaban from the ETNA-AF Europe registry, including 2,885 with diabetes (605 on insulin, 2,151 not on insulin) and 10,248 without diabetes. Mean age ~74, ~56-60% male, multinational (10 European countries).
I
Intervention
Diabetes requiring insulin therapy in patients with atrial fibrillation treated with edoxaban
C
Comparator
Diabetes not requiring insulin therapy, or no diabetes, in patients with atrial fibrillation treated with edoxaban
O
Outcome
Composite of ischemic stroke, transient ischemic attack (TIA), or systemic embolism at 2 yearscomposite

In patients with atrial fibrillation treated with edoxaban, diabetes requiring insulin is an independent risk factor for thromboembolic events, whereas diabetes without insulin carries a similar thromboembolic risk to no diabetes.

Limitations

  • Analyses are not confirmatory, but purely descriptive/exploratory with no adjustment for multiple comparisons
  • HbA1c was measured only in diabetic patients and only in 65% of them
  • Events reported by site investigators (though main outcomes were adjudicated)

Cite This Study

Patti et al. (2022) studied this question.

synapsesocial.com/papers/6a83317fef922d2380583255https://doi.org/10.1007/s00392-022-02080-5
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Association of diabetes mellitus status and clinical outcomes of edoxaban in patients with atrial fibrillation: a sub-analysis from the ETNA-AF Asian registry2026
  2. 2Clinical Outcome of Edoxaban vs. Vitamin K Antagonists in Patients with Atrial Fibrillation and Diabetes Mellitus: Results from a Multicenter, Propensity-Matched, Real-World Cohort Study2020 · 16 citations
  3. 3Edoxaban Antithrombotic Therapy in Diabetic Patients with Atrial Fibrillation and Stable Coronary Artery Disease: The EPIC-CAD Trial2026
  4. 4Impact of diabetes on the management and outcomes in atrial fibrillation: an analysis from the ESC-EHRA EORP-AF Long-Term General Registry2022 · 18 citations
  5. 5Diabetic atrial fibrillation patients: mortality and risk for stroke or embolism during a 10‐year follow‐up2003 · 46 citations