Impact of Non-Vitamin K Antagonist Oral Anticoagulants on Cardiovascular Outcomes in Diabetes Patients with Atrial Fibrillation: A Single-Center Experience.

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are widely used to prevent stroke in patients with atrial fibrillation (AF). Diabetes mellitus (DM) increases the risk of stroke in these patients, necessitating the careful selection of anticoagulant therapy. This study compared the effectiveness and safety of different NOACs in patients with both DM and AF. METHODS: This retrospective cohort study included patients with DM and AF treated with NOACs (apixaban, dabigatran, edoxaban, or rivaroxaban) between December 2012 and June 2022 at a tertiary hospital in Taiwan. The primary outcomes were major adverse cardiovascular events (MACEs), all-cause mortality, and major bleeding. Multivariable Cox proportional hazards models were used to assess the risks associated with each NOAC. RESULTS: After propensity score matching, 700 patients were included in the final analysis. The mean age was 72.71 ± 10.08 years, and the mean CHA2DS2-VASc score was 4.96 ± 1.76. No significant differences were observed among the four NOACs in the risks of acute myocardial infarction, ischemic stroke, or cardiovascular death. Similarly, the risks of intracranial hemorrhage and gastrointestinal bleeding were comparable across groups. However, dabigatran was associated with a significantly lower risk of MACEs (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.19-0.93; p = 0.032) and all-cause mortality (HR, 0.39; 95% CI, 0.15-0.99; p = 0.047) compared with apixaban. CONCLUSIONS: In this single-center study, the risk of major bleeding was similar across the four NOACs. In addition, dabigatran was associated with lower risks of MACEs and all-cause mortality compared with apixaban.