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Published on: February 26, 2013
Diabetes-Related Complications and Mortality in Patients With Atrial Fibrillation Receiving Different Oral
Huei-Kai Huang1, Peter Pin-Sung Liu2, Shu-Man Lin3
1Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, and Department of Family Medicine and Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (H.K.H.).
Insights
Non-vitamin K antagonist oral anticoagulants (NOACs) significantly reduced diabetes complications and mortality in atrial fibrillation patients compared to warfarin. This finding offers crucial insights for managing these complex conditions.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Limited evidence exists on oral anticoagulant risks for diabetes complications in atrial fibrillation (AF) and diabetes mellitus (DM) patients.
- Understanding these risks is crucial for optimizing patient care and treatment strategies.
Purpose of the Study:
- To compare the risks of diabetes complications and mortality between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin users.
- To provide evidence-based guidance for anticoagulant selection in patients with AF and DM.
Main Methods:
- Retrospective cohort study using nationwide Taiwanese health insurance data (2012-2017).
- Compared outcomes between NOAC and warfarin users, employing propensity score methods for confounder balancing.
- Investigated hazards of macrovascular, microvascular, glycemic emergencies, and all-cause mortality.
Main Results:
- NOAC users (19,909) showed significantly lower hazards of macrovascular complications (HR 0.84), microvascular complications (HR 0.79), glycemic emergency (HR 0.91), and mortality (HR 0.78) versus warfarin users (10,300).
- Propensity score matching and sensitivity analyses confirmed these robust findings.
Conclusions:
- NOACs are associated with reduced risks of diabetes complications and mortality compared to warfarin in patients with AF and DM.
- These findings support the use of NOACs for improved outcomes in this patient population.
Background:
Evidence about the association between types of oral anticoagulants and hazards of diabetes complications is limited in patients with atrial fibrillation (AF) and diabetes mellitus (DM).
Objective:
To compare the hazards of diabetes complications and mortality between patients with AF and DM receiving non-vitamin K antagonist oral anticoagulants (NOACs) and those receiving warfarin.
Design:
A retrospective cohort study.
Setting:
Nationwide data obtained from Taiwan's National Health Insurance Research Database.
Patients:
Patients with AF and DM receiving NOACs or warfarin between 2012 and 2017 in Taiwan were enrolled. Treatment groups were determined by patients' first initiation of oral anticoagulants.
Measurements:
Hazards of diabetes complications (macrovascular complications, microvascular complications, and glycemic emergency) and mortality in the NOAC and warfarin users were investigated with a target trial design. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HRs). Propensity score methods with stabilized inverse probability of treatment weighting were applied to balance potential confounders between treatment groups.
Results:
In total, 19 909 NOAC users and 10 300 warfarin users were included. Patients receiving NOACs had significantly lower hazards of developing macrovascular complications (HR, 0.84 [95% CI, 0.78 to 0.91]; P < 0.001), microvascular complications (HR, 0.79 [CI, 0.73 to 0.85]; P < 0.001), glycemic emergency (HR, 0.91 [CI, 0.83 to 0.99]; P = 0.043), and mortality (HR, 0.78 [CI, 0.75 to 0.82]; P < 0.001) than those receiving warfarin. Analyses with propensity score matching showed similar results. Several sensitivity analyses further supported the robustness of our findings.
Limitation:
The claims-based data did not allow for detailed data on patients' lifestyles and laboratory examinations to be obtained.
Conclusion:
Non-vitamin K antagonist oral anticoagulants were associated with lower hazards of diabetes complications and mortality than warfarin in patients with AF and DM.
Primary Funding Source:
Hualien Tzu Chi Hospital.
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