What does this research mean for the field?

In diabetic patients with non-valvular atrial fibrillation, dabigatran is associated with a significantly lower risk of all-cause mortality compared to both warfarin and rivaroxaban. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2018

Is There a Preferred Stroke Prevention Strategy for Diabetic Patients with Non-Valvular Atrial Fibrillation? Comparing Warfarin, Dabigatran and Rivaroxaban

CHChih-Cheng HsuNational Health Research Institutes PHPai‐Feng HsuNational Yang Ming Chiao Tung University SSShih‐Hsien SungInterventional Cardiology

Key Result

The provided text contains only the editorial board and masthead information for the journal Thrombosis and Haemostasis, with no clinical study data.

Structured PICO

Does dabigatran or rivaroxaban reduce thromboembolic events, bleeding, and mortality compared to warfarin in diabetic patients with non-valvular atrial fibrillation?

Population

814,465 diabetic patients with non-valvular atrial fibrillation in Taiwan

Intervention

Dabigatran or rivaroxaban

Comparator

Warfarin (and direct comparison between dabigatran and rivaroxaban)

Outcome

Thromboembolic events, bleeding, and mortalityhard clinical

In diabetic patients with non-valvular atrial fibrillation, dabigatran is associated with significantly lower all-cause mortality and gastrointestinal bleeding compared to warfarin, and lower mortality compared to rivaroxaban.

Abstract

BACKGROUND: The prevalence of diabetes is growing, and diabetes is an independent risk factor for both atrial fibrillation (AF) and stroke. However, the relative effectiveness and safety of different oral anticoagulants for diabetic patients with non-valvular AF remain unclear. We aimed to compare thromboembolic events, bleeding and mortality in diabetic AF patients treated with rivaroxaban, dabigatran and warfarin. METHODS AND RESULTS: = 814,465) in Taiwan. Outcomes and comorbidities were evaluated by linking with Taiwan National Health Insurance Research Database. Propensity score weighting method was used to balance covariates across study groups. Patients were followed up until the first occurrence of any study outcome or the study end date. Compared with warfarin, dabigatran significantly decreased the risk of all-cause mortality (hazard ratio HR = 0.348, 95% confidence interval CI = 0.157-0.771) and gastrointestinal bleeding (HR = 0.558, 95% CI = 0.327-0.955). Relative effectiveness and safety outcomes between rivaroxaban and warfarin were comparable. Compared with rivaroxaban, dabigatran significantly decreased the risk of all-cause mortality (HR = 0.310, 95% CI = 0.121-0.798) and was associated with a borderline reduced risk for composite safety end points (HR = 0.670, 95% CI = 0.421-1.067). CONCLUSION: In diabetic AF patients, dabigatran and rivaroxaban showed a superior or non-inferior effectiveness and safety profile compared with warfarin. Dabigatran was associated with a significantly lower risk of mortality than rivaroxaban.

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