Abstract
Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.
Highlights
Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF)
Considering the fact that the prevalence of hypertension and vascular diseases is high among T2D patients, there is a high probability that T2D patients with newly onset AF would require long-term anticoagulation for prevention of future embolic events
T2D and previous AF were identified in a fully adjusted multivariable logistic regression analysis as significant risk factors for ischemic stroke in individuals who developed their first event of stroke at the age of 25 to 49 years [21]. This observation suggests that T2D patients with AF are at a higher risk of early-onset stroke compared with nondiabetic individuals
Summary
Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF). T2D and previous AF were identified in a fully adjusted multivariable logistic regression analysis as significant risk factors for ischemic stroke in individuals who developed their first event of stroke at the age of 25 to 49 years [21] This observation suggests that T2D patients with AF are at a higher risk of early-onset stroke compared with nondiabetic individuals. Direct (novel, non-vitamin K-dependent) oral anticoagulants (DOACs) offer several advantages, such as more predictable inhibition of coagulation compared to VKA, more rapid on- and offset of action, shorter plasma half-life, lower risk of food and drug interactions, and no need for a routine laboratory monitoring of achieved anticoagulant activity Due to these advantages, DOACs should be recently preferred for long-term oral anticoagulation in AF patients [5]. The question is: do we have sufficient data on the efficacy and safety of DOACs in T2D patients with AF?
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