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http://hdl.handle.net/10397/90744
Title: | Treatment with direct oral anticoagulants or warfarin and the risk for incident diabetes among patients with atrial fibrillation : a population‐based cohort study | Authors: | Cheung, CL Sing, CW Lau, WCY Li, GHY Lip, GYH Tan, KCB Cheung, BMY Chan, EWY Wong, ICK |
Issue Date: | 2021 | Source: | Cardiovascular diabetology, 2021, v. 20, no. 1, 71 | Abstract: | Background: Diabetes 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. Methods: Population-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). Results: There 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. Conclusions: Among adults with AF receiving OACs, the use of dabigatran had the lowest risk of diabetes when compared with warfarin use. |
Keywords: | Anti-coagulant Association Atrial fibrillation Diabetes DOAC Epidemiology Pharmacoepidemiology Warfarin |
Publisher: | BioMed Central | Journal: | Cardiovascular diabetology | EISSN: | 1475-2840 | DOI: | 10.1186/s12933-021-01263-0 | Rights: | © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat ivecommons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. The following publication Cheung, CL., Sing, CW., Lau, W.C.Y. et al. Treatment with direct oral anticoagulants or warfarin and the risk for incident diabetes among patients with atrial fibrillation: a population‐based cohort study. Cardiovasc Diabetol 20, 71 (2021) is available at https://doi.org/10.1186/s12933-021-01263-0 |
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