Use of non‐vitamin K oral anticoagulants in people with atrial fibrillation and diabetes mellitus

• Published in: Diabetic medicine Vol. 35; no. 5; pp. 548 - 556
• Main Authors: Itzhaki Ben Zadok, O., Eisen, A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2018
• Subjects: Anticoagulants; Anticoagulants - therapeutic use; Antithrombins - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular diseases; Clinical Trials, Phase III as Topic; Coagulation; Comorbidity; Coronary artery; Coronary Artery Disease - epidemiology; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Embolism; Factor Xa Inhibitors - therapeutic use; Fibrillation; Heart diseases; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Hypertension - epidemiology; Reviews; Safety; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Treatment Outcome; Vitamin K; Warfarin
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13600

Aims To examine the efficacy and safety of non‐vitamin K oral anticoagulants in people with both atrial fibrillation and diabetes mellitus. Methods We reviewed efficacy and safety data from the warfarin‐controlled phase III non‐vitamin K oral anticoagulants trials (ARISTOTLE, RE‐LY, ROCKET‐AF, ENGAGE AF‐TIMI 48) and their post hoc analyses with regard to diabetes status. We also reviewed the updated literature regarding this population. Results At baseline 20–40% of the participants in the phase III non‐vitamin K oral anticoagulants trials had diabetes mellitus at baseline. This population, in comparison with those without diabetes, was more likely to have other comorbidities, such as hypertension and coronary artery disease; thus, their cardiovascular risk was higher. Participants with diabetes had higher rates of stroke and systemic embolism than participants without diabetes. This risk was decreased using non‐vitamin K oral anticoagulants, with no significant interaction by diabetic status or the specific drug used. Overall, compared with warfarin, non‐vitamin K oral anticoagulants were safe and reduced the incidence of major bleeding in people with atrial fibrillation and diabetes, although the results varied with the different non‐vitamin K oral anticoagulants. Conclusions The efficacy and safety of non‐vitamin K oral anticoagulants compared with warfarin generally extend to participants with diabetes mellitus, although dedicated randomized trials or real‐world data are lacking. What's new? This review describes the characteristics and methods of phase III trials of non‐vitamin K oral anticoagulants with regard to diabetes mellitus status. We review the existing data concerning the efficacy and safety of the use of non‐vitamin K oral anticoagulants in people with atrial fibrillation and diabetes. Although real‐world data are lacking, evidence suggests that all available non‐vitamin K oral anticoagulants are as efficient and safe in people with diabetes as in people without diabetes.