PDF icon Download PDF
Thromb Haemost 2018; 118(01): 072-081
DOI: 10.1160/TH17-02-0095
Coagulation and Fibrinolysis
Schattauer GmbH Stuttgart

Is There a Preferred Stroke Prevention Strategy for Diabetic Patients with Non-Valvular Atrial Fibrillation? Comparing Warfarin, Dabigatran and Rivaroxaban

Chih-Cheng Hsu
,
Pai-Feng Hsu
,
Shih-Hsien Sung
,
Shih-Te Tu
,
Ben-Hui Yu
,
Chi-Jung Huang
,
Hao-Min Cheng
Further Information

Publication History

10 February 2017

28 September 2017

Publication Date:
05 January 2018 (online)

   Permissions and Reprints
Preview

Abstract

Background The prevalence of diabetes is growing, and diabetes is an independent risk factor for both atrial fibrillation (AF) and stroke. However, the relative effectiveness and safety of different oral anticoagulants for diabetic patients with non-valvular AF remain unclear. We aimed to compare thromboembolic events, bleeding and mortality in diabetic AF patients treated with rivaroxaban, dabigatran and warfarin.

Methods and Results Diabetic AF patients taking dabigatran (n = 322), rivaroxaban (n = 320) or warfarin (n = 1,899) were identified from the nationwide diabetes pay-for-performance program (n = 814,465) in Taiwan. Outcomes and comorbidities were evaluated by linking with Taiwan National Health Insurance Research Database. Propensity score weighting method was used to balance covariates across study groups. Patients were followed up until the first occurrence of any study outcome or the study end date. Compared with warfarin, dabigatran significantly decreased the risk of all-cause mortality (hazard ratio [HR] = 0.348, 95% confidence interval [CI] = 0.157–0.771) and gastrointestinal bleeding (HR = 0.558, 95% CI = 0.327–0.955). Relative effectiveness and safety outcomes between rivaroxaban and warfarin were comparable. Compared with rivaroxaban, dabigatran significantly decreased the risk of all-cause mortality (HR = 0.310, 95% CI = 0.121–0.798) and was associated with a borderline reduced risk for composite safety end points (HR = 0.670, 95% CI = 0.421–1.067).

Conclusion In diabetic AF patients, dabigatran and rivaroxaban showed a superior or non-inferior effectiveness and safety profile compared with warfarin. Dabigatran was associated with a significantly lower risk of mortality than rivaroxaban.

Keywords

cardiovascular events - diabetes - atrial fibrillation - anticoagulation - stroke prevention

Authors' Contributions

C.-C. H. and H.-M. C. conducted study design, wrote the manuscript and interpreted data. P.-F. H. and S.-H. S. reviewed/edited the manuscript. S.-T. T. and B.-H. Y. analysed data and revised the manuscript. All authors read and approved the final manuscript.


Funding

The study was supported by Ministry of Health and Welfare, Taiwan grant (MOHW-104-TDU-B-211–113003, MOHW-105-TDU-B-211–133017, 05D9-PHBHP01, and MOHW-106-TDU-B-211-113001).


Supplementary Material