Net clinical benefit of direct oral anticoagulants in atrial fibrillation patients with or without diabetes mellitus: A meta-analysis of outcome trials

Abstract

AimTo evaluate the net clinical benefit following direct oral anticoagulants (DOACs) vs warfarin by diabetes status in patients with non-valvular atrial fibrillation. MethodsWe searched 3 electronic databases through end-February 2021 to identify relevant outcome trials in patients with and without diabetes mellitus (DM). All-cause death, non-fatal stroke/systemic embolism and major bleedings defined net clinical benefit. Outcome risk ratios and 95% confidence interval (CI), and absolute risk outcome reduction per 1000 treated patients were assessed. ResultsFour trials of DOACs vs warfarin compared 22,087 patients with DM to 49,592 patients without DM. CHADS2 and 10-year fatal cardiovascular risk were higher in patients with vs those without DM (3.7 vs 2.5 and 28.4% vs 23.4%, respectively). DOACs were associated with more favorable net clinical benefit compared to warfarin in patients with and without DM (relative risk reduction, 0.85 [95% CI, 0.81–0.89] and 0.87 [95% CI, 0.79–0.96]; absolute risk reduction per 1000 patients treated, −33 [95% CI, −45, −21]) and −24 [95% CI, −43, −5]), but interaction test was not significant by relative and absolute numbers (P = 0.68 and P = 0.44, respectively). ConclusionNet clinical benefit following DOACs was not different between patients with and without DM over a period of 2.2 years.