NOACs or Warfarin in Atrial Fibrillation With Diabetes

In a recent meta-analysis, researchers found that new direct oral anticoagulants (NOACs) demonstrated lower rates of stroke or systemic embolism (SSE), ischemic stroke, and hemorrhagic stroke in patients with nonvalvular atrial fibrillation (NVAF) and diabetes mellitus compared with warfarin. Additionally, NOACs did not significantly increase the risk of major bleeding. The results were published in the Journal of Translational Medicine.

The researchers assessed 5 retrospective studies and 4 subgroup analyses of randomized controlled trials from the PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases. The pooled cohort included 267,272 patients.

NOACs Versus Warfarin in Atrial Fibrillation With Diabetes Mellitus

According to the authors, NOACs significantly reduced SSE risk compared with warfarin (pooled hazard ratio [HR], 0.80; 95% CI, 0.74-0.85) in both types of studies. NOACs also appeared to reduce major bleeding risk for patients with atrial fibrillation and diabetes mellitus (pooled HR, 0.85; 95% CI, 0.73-0.99), though the authors noted there was significant heterogeneity among the included studies.

Additionally, the researchers found differences between NOACs and warfarin in risk for the following outcomes:

  • ischemic stroke (pooled HR, 0.84; 95% CI, 0.78-0.91)
  • hemorrhagic stroke (pooled HR, 0.50; 95% CI, 0.42-0.60)
  • intracranial bleeding (pooled HR, 0.63; 95% CI, 0.47-0.84)
  • gastrointestinal bleeding (pooled HR, 0.77; 95% CI, 0.63-0.95)
  • vascular death (pooled HR, 0.82; 95% CI, 0.71-0.95)
  • myocardial infarction (pooled HR, 0.84; 95% CI, 0.72-0.98)
  • all-cause mortality (pooled HR, 0.86; 95% CI, 0.72-1.02)

Despite limitations, including not assessing additional diabetes mellitus biomarkers, as well as potential biases across the included studies, the authors ultimately suggested “NOACs may be a better choice for anticoagulation in patients with NVAF and diabetes.”

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