• Lip Gregory Y H GYH Liverpool Centre for Cardiovascular Science, at the Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, United Kingdom; Aalborg Thro, Allison V Keshishian, Amiee L Kang, Xiaoyan Li, Amol D Dhamane, Xuemei Luo, Neeraja Balachander, Lisa Rosenblatt, Jack Mardekian, Anagha Nadkarni, Xianying Pan, Manuela Di Fusco, Alessandra B Garcia Reeves, Huseyin Yuce, and Steven B Deitelzweig.
• Liverpool Centre for Cardiovascular Science, at the Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: Gregory.Lip@liverpool.ac.uk.
• Mayo Clin. Proc. 2020 May 1; 95 (5): 929-943.

ObjectiveTo address gaps in the data comparing non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin among patients with nonvalvular atrial fibrillation (NVAF) and diabetes.Patients And MethodsA retrospective study was conducted on patients with NVAF and diabetes newly initiating apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with Medicare data from the US Centers for Medicare & Medicaid Services and 4 other US commercial claims databases. One-to-one propensity score matching was completed between NOACs and warfarin and between NOACs in each database, and the results were pooled. Cox proportional hazards models were used to evaluate the risk of stroke/systemic embolism (SE) and major bleeding (MB).ResultsA total of 154,324 patients were included in the 6 matched cohorts, with a mean follow-up time of 6 to 8 months. Compared with warfarin, apixaban (hazard ratio [HR], 0.67; 95% CI, 0.57-0.77) and rivaroxaban (HR, 0.79; 95% CI, 0.71-0.89) were associated with a lower risk of stroke/SE; dabigatran (HR, 0.84; 95% CI, 0.67-1.07) was associated with a similar risk of stroke/SE. Apixaban (HR, 0.60; 95% CI, 0.56-0.65) and dabigatran (HR, 0.78; 95% CI, 0.69-0.88) were associated with a lower risk of MB; rivaroxaban (HR, 1.02; 95% CI, 0.94-1.10) was associated with a similar risk of MB compared with warfarin. Compared with dabigatran and rivaroxaban, apixaban was associated with a lower risk of MB. Compared with rivaroxaban, dabigatran was associated with a lower risk of MB.ConclusionThis study-the largest observational study to date of patients with NVAF and diabetes taking anticoagulants-found that NOACs were associated with variable rates of stroke/SE and MB compared with warfarin.Trial Registrationclinicaltrials.gov Identifier: NCT03087487.Copyright © 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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