Prevention of cardiovascular outcomes in diabetic patients with atrial fibrillation: direct oral anticoagulants or warfarin?

The association of atrial fibrillation (AF) and type 2 diabetes is frequently encountered in clinical practice and results in an increased risk of stroke, systemic embolism, myocardial infarction and other cardiovascular outcomes. Meta-analysis of the randomized clinical trials, including ROCKET AF, RELY, ARISTOTLE, and ENGAGE AF, which studied the efficacy and safety of rivaroxaban, dabigatran, apixaban, and edoxaban in patients with AF, showed that treatment with direct oral anticoagulants in patients with concurrent diabetes mellitus was associated with a lower risk of stroke and systemic embolism (0.80, 95% CI 0.63-0.93) compared with warfarin. Moreover, the new oral anticogulants showed a favourable balance between efficacy and safety compared with warfarin in patients with AF and chronic kidney disease that frequently develops in diabetic patients. The presence and the severity of renal dysfunction should be taken into account when choosing the direct oral anticoagulant and its dose.

Key words

Atrial fibrillation, diabetes mellitus, stroke, systemic embolism, direct oral anticoagulans.