Non-vitamin K oral anticoagulants provide a greater absolute benefit than vitamin K antagonists in preventing arterial thromboembolism in patients with atrial fibrillation and type 2 diabetes.
Do non-vitamin K antagonist oral anticoagulants provide greater benefit than vitamin K antagonists in preventing arterial thromboembolism in patients with atrial fibrillation and type 2 diabetes?
This review highlights the increased thromboembolic risk in patients with both AF and type 2 diabetes and suggests NOACs provide greater absolute benefit than VKAs in this population.
IMPORTANCE: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a 5-fold increase in the risk for stroke. Type 2 diabetes is an independent risk factor for both stroke and atrial fibrillation, and in the setting of AF, type 2 diabetes is independently associated with a 2% to 3.5% increase in absolute stroke rate per year. The overlap in the pathophysiologies of AF and type 2 diabetes are not well understood, and current practice guidelines provide few recommendations regarding patients with both conditions. OBSERVATIONS: In this article, we review the epidemiology and pathophysiology of the nexus of AF and type 2 diabetes. Furthermore, we analyze the subgroup of patients with type 2 diabetes enrolled in phase 3 clinical trials of non-vitamin K antagonist oral anticoagulants in prevention of arterial thromboembolism in AF, highlighting the greater absolute benefit of non-vitamin K oral anticoagulants in patients with type 2 diabetes. Finally, we offer recommendations on risk stratification and therapy for patients with concomitant AF and type 2 diabetes. CONCLUSIONS AND RELEVANCE: We highlight the increased thromboembolic risk with coexisting AF and type 2 diabetes. We recommend that further studies be done to evaluate the potential benefits of anticoagulation for all patients who have both and the potential for non-vitamin K oral anticoagulants to have greater benefits than risks over vitamin K antagonists.
Plitt et al. (2017) conducted a review in Atrial fibrillation and type 2 diabetes. Non-vitamin K antagonist oral anticoagulants vs. Vitamin K antagonists was evaluated. Non-vitamin K oral anticoagulants provide a greater absolute benefit than vitamin K antagonists in preventing arterial thromboembolism in patients with atrial fibrillation and type 2 diabetes.