Diabetes-Related Complications and Mortality in Patients With Atrial Fibrillation Receiving Different Oral Anticoagulants A Nationwide Analysis

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 complica-tions and mortality between patients with AF and DM receiv-ing 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 warfa-rin between 2012 and 2017 in Taiwan were enrolled. Treatment groups were determined by patients' first initiation of oral anticoagulants. Measurements: Hazards of diabetes complications (mac-rovascular complications, microvascular complications, and glycemic emergency) and mortality in the NOAC and warfa-rin 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, 19909 NOAC users and 10300 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 complica-tions and mortality than warfarin in patients with AF and DM. Primary Funding Source: Hualien Tzu Chi Hospital.