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Meta-Analysis
. 2021 Oct 11:2021:5520027.
doi: 10.1155/2021/5520027. eCollection 2021.

Efficacy and Safety of Direct Oral Anticoagulants in Patients with Diabetes and Nonvalvular Atrial Fibrillation: Meta-Analysis of Observational Studies

Bo Cao  1 , Xingcan Yao  1 , Lifang Zhang  1 , Xiaobo Hu  1 , Min Chen  2 , Mingfeng Shen  1 , Lan Xu  1
Affiliations
Meta-Analysis

Efficacy and Safety of Direct Oral Anticoagulants in Patients with Diabetes and Nonvalvular Atrial Fibrillation: Meta-Analysis of Observational Studies

Bo Cao et al. Cardiovasc Ther. .

Abstract

Background: This meta-analysis was performed to compare the efficacy and safety of direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) for stroke prevention in real-world patients with diabetes and nonvalvular atrial fibrillation (NVAF) through observational studies.

Methods: PubMed, Embase, and Web of Science databases were searched up to August 2020 for eligible studies. Outputs were presented as risk ratios (RRs) and corresponding 95% confidence intervals (CIs) by using a random-effect model.

Results: Seven observational studies involving 249,794 diabetic NVAF patients were selected. Compared with VKAs, the use of DOACs was associated with significantly reduced risks of stroke (RR = 0.56, 95% CI 0.45-0.70; p < 0.00001), ischemic stroke (RR = 0.61, 95% CI 0.48-0.78; p < 0.0001), stroke or systemic embolism (SSE) (RR = 0.81, 95% CI 0.68-0.95; p = 0.01), myocardial infarction (RR = 0.69, 95% CI 0.55-0.88; p = 0.002), major bleeding (RR = 0.75, 95% CI 0.63-0.90; p = 0.002), intracranial hemorrhage (RR = 0.50, 95% CI 0.44-0.56; p < 0.00001), and major gastrointestinal bleeding (RR = 0.77, 95% CI 0.62-0.95; p = 0.02), and a borderline significant decrease in major adverse cardiac events (RR = 0.87, 95% CI 0.75-1.00; p = 0.05) in NVAF patients with diabetes.

Conclusion: For patients with NVAF and diabetes in real-world clinical settings, DOACs showed superior efficacy and safety profile over VKAs and significantly reduced risks of stroke, ischemic stroke, SSE, myocardial infarction, major bleeding, intracranial hemorrhage, and major gastrointestinal bleeding.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot comparing DOACs vs. VKAs regarding SSE in real-world NVAF patients with diabetes. SSE: stroke or systemic embolism; NVAF: nonvalvular atrial fibrillation; DOACs: direct oral anticoagulants; VKAs: vitamin K antagonists; API: apixaban; DAB: dabigatran; EDO: edoxaban; RIV: rivaroxaban.
Figure 2
Figure 2
Forest plot comparing DOACs vs. VKAs regarding myocardial infarction in real-world NVAF patients with diabetes. NVAF: nonvalvular atrial fibrillation; DOACs: direct oral anticoagulants; VKAs: vitamin K antagonists; API: apixaban; DAB: dabigatran; EDO: edoxaban; RIV: rivaroxaban.
Figure 3
Figure 3
Forest plot comparing DOACs vs. VKAs regarding MACE in real-world NVAF patients with diabetes. MACE: major adverse cardiac events; NVAF: nonvalvular atrial fibrillation; DOACs: direct oral anticoagulants; VKAs: vitamin K antagonists; API: apixaban; DAB: dabigatran; EDO: edoxaban; RIV: rivaroxaban.
Figure 4
Figure 4
Forest plot comparing DOACs vs. VKAs regarding major bleeding in real-world NVAF patients with diabetes. NVAF: nonvalvular atrial fibrillation; DOACs: direct oral anticoagulants; VKAs: vitamin K antagonists; API: apixaban; DAB: dabigatran; EDO: edoxaban; RIV: rivaroxaban.
Figure 5
Figure 5
Forest plot comparing DOACs vs. VKAs regarding intracranial hemorrhage in real-world NVAF patients with diabetes. NVAF: nonvalvular atrial fibrillation; DOACs: direct oral anticoagulants; VKAs: vitamin K antagonists; API: apixaban; DAB: dabigatran; EDO: edoxaban; RIV: rivaroxaban.
Figure 6
Figure 6
Forest plot comparing DOACs vs. VKAs regarding major gastrointestinal bleeding in real-world NVAF patients with diabetes. NVAF: nonvalvular atrial fibrillation; DOACs: direct oral anticoagulants; VKAs: vitamin K antagonists; API: apixaban; DAB: dabigatran; EDO: edoxaban; RIV: rivaroxaban.
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References

    1. Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–988. doi: 10.1161/01.STR.22.8.983. - DOI - PubMed
    1. Movahed M. R., Hashemzadeh M., Mazen Jamal M. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. International Journal of Cardiology. 2005;105(3):315–318. doi: 10.1016/j.ijcard.2005.02.050. - DOI - PubMed
    1. Klem I., Wehinger C., Schneider B., Hartl E., Finsterer J., Stöllberger C. Diabetic atrial fibrillation patients: mortality and risk for stroke or embolism during a 10-year follow-up. Diabetes/Metabolism Research and Reviews. 2003;19(4):320–328. doi: 10.1002/dmrr.386. - DOI - PubMed
    1. Lip G. Y., Nieuwlaat R., Pisters R., Lane D. A., Crijns H. J. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137(2):263–272. doi: 10.1378/chest.09-1584. - DOI - PubMed
    1. Huxley R. R., Alonso A., Lopez F. L., et al. Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities Study. Heart. 2012;98(2):133–138. doi: 10.1136/heartjnl-2011-300503. - DOI - PMC - PubMed

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