Risk of diabetic retinopathy and ophthalmic interventions in patients with diabetes mellitus taking different oral anticoagulants

To evaluate risks of developing diabetic retinopathy (DR) and vision-threatening DR requiring interventions in patients with diabetes mellitus (DM) receiving non-vitamin K antagonist oral anticoagulants (NOACs) compared with those taking warfarin.

This retrospective cohort study included 375 280 and 122 979 patients with DM initiated on NOACs and warfarin, respectively, before propensity score matching (PSM). TriNetX was used to identify patients with DM treated with NOACs or warfarin. PSM was performed to control for baseline demographics and medical comorbidities. Outcome measures included hazard ratios (HR) of developing DR, proliferative DR (PDR), diabetic macular oedema (DME) and requiring an ocular intervention within 6 months, 1 year, 3 years and 5 years.

NOACs and warfarin cohorts contained 122 979 patients. Patients receiving NOACs had significantly lower risks of DR (6 months: HR, 0.66; 95% confidence interval [95% CI], 0.60-0.72; 1 year: HR, 0.68; 95% CI, 0.63-0.73; 3 years: HR, 0.70; 95% CI, 0.67-0.74; 5 years: HR, 0.73; 95% CI, 0.70-0.76). The robustness of these findings extended to all secondary endpoints, including the incidence of PDR, DME and the need for treatments for vision-threatening DR, across all follow-up intervals (6 months, 1 years, 3 years and 5 years).

Taking NOACs was associated with lower risks of developing DM-related ocular complications than taking warfarin in patients with DM.