Treatment with direct oral anticoagulants or warfarin and the risk for incident diabetes among patients with atrial fibrillation: a population‐based cohort study

Cardiovascular Diabetology

Gloria H. Y. Li¹  Bernard M. Y. Cheung²  Kathryn C. B. Tan²  Ching-Lung Cheung³  Esther W. Y. Chan³  Chor-Wing Sing³  Wallis C. Y. Lau⁴  Ian C. K. Wong⁴  Gregory Y. H. Lip⁵ 

[1] Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China;Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China;Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China;Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK;Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK;Liverpool Health Partners, Liverpool, UK;

关键词: Diabetes;    Atrial fibrillation;    Anti-coagulant;    Pharmacoepidemiology;    DOAC;    Warfarin;    Association;    Epidemiology;   

DOI  :  10.1186/s12933-021-01263-0

来源: Springer

【 摘 要 】

BackgroundDiabetes mellitus is a common comorbidity of atrial fibrillation (AF), which can complicate the management of AF. The pharmacology of oral anticoagulants (OACs) have been implicated in pathogenesis of diabetes, but the relationship between different OACs and risk of diabetes remains unexamined. This study aimed to evaluate the risk of diabetes with use of different OACs in AF patients.MethodsPopulation-based retrospective cohort study using an electronic healthcare database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with AF from 2014 through 2018 and prescribed OACs were included and followed till December 31, 2019. Inverse probability of treatment weighting based on the propensity score (PS) is used to address potential bias due to nonrandomized allocation of treatment. The risks ofdiabetes were compared between different new OAC users using propensity score-weighted cumulative incidence differences (CID).ResultsThere were 13,688 new users of OACs (warfarin: n = 3454; apixaban: n = 3335; dabigatran: n = 4210; rivaroxaban: n = 2689). The mean age was 75.0 (SD, 11.2), and 6,550 (47.9%) were women. After a median follow-up of 0.93 years (interquartile range, 0.21–1.92 years), 698 incident diabetes cases were observed. In Cox-regression analysis, dabigatran use was significantly associated with reduced risk of diabetes when compared with warfarin use [HR 0.69 (95% CI 0.56–0.86; P < 0.001)], with statistically insignificant associations observed for use of apixaban and rivaroxaban. The corresponding adjusted CIDs at 2 years after treatment with apixaban, dabigatran, and rivaroxaban users when compared with warfarin were − 2.06% (95% CI − 4.08 to 0.16%); − 3.06% (95% CI − 4.79 to − 1.15%); and − 1.8% (− 3.62 to 0.23%). In head-to-head comparisons between women DOAC users, dabigatran was also associated with a lower risk of diabetes when compared with apixaban and rivaroxaban.ConclusionsAmong adults with AF receiving OACs, the use of dabigatran had the lowest risk of diabetes when compared with warfarin use.

【 授权许可】

CC BY