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NOAC could be better than warfarin in diabetes patients with atrial fibrillation

Annals of Internal Medicine
Reuters Health - 15/02/2022 - Treatment with a non-vitamin K-antagonist oral anticoagulant (NOAC) may be a better therapeutic choice than warfarin in diabetes patients with atrial fibrillation (AF), according to a retrospective study from Taiwan.

Compared with warfarin, treatment with a NOAC was associated with a lower risk of diabetes complications and mortality, researchers report in Annals of Internal Medicine.

There is only limited evidence about the association between types of oral anticoagulants and risks of diabetes complications in patients with AF and diabetes, Dr. Huei-Kai Huang of National Taiwan University, in Taipei, and colleagues point out.

To investigate, they used Taiwan's National Health Insurance Research Database to identify more than 19,900 adults with AF and diabetes using a NOAC and 10,300 peers using warfarin.

Compared with warfarin users, NOAC users had lower risk of developing macrovascular complications (hazard ratio, 0.84; P<0.001), microvascular complications (HR, 0.79; P<0.001), glycemic emergency (HR, 0.91; P=0.043), and dying (HR: 0.78; P<0.001).

"Analyses with propensity score matching showed similar results. Several sensitivity analyses further supported the robustness of our findings," the study team reports.

They note that the precise mechanisms of the better outcomes in NOAC users is unclear, but possible contributing factors could include the beneficial effects of vitamin K on insulin sensitivity and glucose tolerance and the difference in anticoagulation mechanisms between NOACs and warfarin.

They encourage future research to determine the causal relationships.

The study had no commercial funding.

SOURCE: https://bit.ly/3rRjGKC Annals of Internal Medicine, online February 14, 2022.

By Reuters Staff

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