直接口服抗凝剂或华法林治疗与房颤患者新发糖尿病风险：一项基于人群的队列研究。
Treatment with direct oral anticoagulants or warfarin and the risk for incident diabetes among patients with atrial fibrillation: a population-based cohort study.
机构信息
Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
出版信息
Cardiovasc Diabetol. 2021 Mar 25;20(1):71. doi: 10.1186/s12933-021-01263-0.
BACKGROUND
Diabetes mellitus is a common comorbidity of atrial fibrillation (AF), which can complicate the management of AF. The pharmacology of oral anticoagulants (OACs) have been implicated in pathogenesis of diabetes, but the relationship between different OACs and risk of diabetes remains unexamined. This study aimed to evaluate the risk of diabetes with use of different OACs in AF patients.
METHODS
Population-based retrospective cohort study using an electronic healthcare database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with AF from 2014 through 2018 and prescribed OACs were included and followed till December 31, 2019. Inverse probability of treatment weighting based on the propensity score (PS) is used to address potential bias due to nonrandomized allocation of treatment. The risks ofdiabetes were compared between different new OAC users using propensity score-weighted cumulative incidence differences (CID).
RESULTS
There were 13,688 new users of OACs (warfarin: n = 3454; apixaban: n = 3335; dabigatran: n = 4210; rivaroxaban: n = 2689). The mean age was 75.0 (SD, 11.2), and 6,550 (47.9%) were women. After a median follow-up of 0.93 years (interquartile range, 0.21-1.92 years), 698 incident diabetes cases were observed. In Cox-regression analysis, dabigatran use was significantly associated with reduced risk of diabetes when compared with warfarin use [HR 0.69 (95% CI 0.56-0.86; P < 0.001)], with statistically insignificant associations observed for use of apixaban and rivaroxaban. The corresponding adjusted CIDs at 2 years after treatment with apixaban, dabigatran, and rivaroxaban users when compared with warfarin were - 2.06% (95% CI - 4.08 to 0.16%); - 3.06% (95% CI - 4.79 to - 1.15%); and - 1.8% (- 3.62 to 0.23%). In head-to-head comparisons between women DOAC users, dabigatran was also associated with a lower risk of diabetes when compared with apixaban and rivaroxaban.
CONCLUSIONS
Among adults with AF receiving OACs, the use of dabigatran had the lowest risk of diabetes when compared with warfarin use.
背景
糖尿病是心房颤动（AF）的常见合并症，这可能会使 AF 的治疗复杂化。口服抗凝剂（OACs）的药理学与糖尿病的发病机制有关，但不同 OACs 与糖尿病风险之间的关系仍未得到检验。本研究旨在评估 AF 患者使用不同 OAC 治疗的糖尿病发病风险。
方法
这是一项基于电子医疗数据库的回顾性队列研究，该数据库由香港医院管理局管理。纳入 2014 年至 2018 年期间新诊断为 AF 并接受 OAC 治疗的患者，并随访至 2019 年 12 月 31 日。采用基于倾向评分（PS）的逆概率治疗加权（IPTW）来解决由于治疗分配非随机而导致的潜在偏倚。采用倾向评分加权累积发生率差异（CID）比较不同新型 OAC 使用者的糖尿病发病风险。
结果
共纳入 13688 例新使用 OAC 治疗的患者（华法林：n=3454；阿哌沙班：n=3335；达比加群：n=4210；利伐沙班：n=2689）。平均年龄为 75.0（标准差，11.2）岁，6550 例（47.9%）为女性。中位随访时间为 0.93 年（四分位距，0.21-1.92 年），共观察到 698 例糖尿病发病事件。Cox 回归分析显示，与华法林相比，达比加群的使用与糖尿病发病风险降低显著相关[风险比 0.69（95%置信区间 0.56-0.86；P<0.001）]，而阿哌沙班和利伐沙班的使用与糖尿病发病风险无显著关联。与华法林相比，阿哌沙班、达比加群和利伐沙班治疗 2 年后的相应校正 CID 分别为-2.06%（95%置信区间-4.08 至 0.16%）、-3.06%（95%置信区间-4.79 至-1.15%）和-1.8%（-3.62 至 0.23%）。在比较女性 DOAC 使用者时，与阿哌沙班和利伐沙班相比，达比加群的使用与较低的糖尿病发病风险相关。
结论
在接受 OAC 治疗的 AF 成年患者中，与华法林相比，达比加群的糖尿病发病风险最低。
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