接受不同口服抗凝剂治疗的心房颤动患者的糖尿病相关并发症和死亡率：一项全国性分析。

Diabetes-Related Complications and Mortality in Patients With Atrial Fibrillation Receiving Different Oral Anticoagulants : A Nationwide Analysis.

作者信息

Huang Huei-Kai, Liu Peter Pin-Sung, Lin Shu-Man, Hsu Jin-Yi, Yeh Jih-I, Lai Edward Chia-Cheng, Peng Carol Chiung-Hui, Munir Kashif M, Loh Ching-Hui, Tu Yu-Kang

机构信息

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, and Department of Family Medicine and Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (H.K.H.).

Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan (P.P.S.L.).

出版信息

Ann Intern Med. 2022 Apr;175(4):490-498. doi: 10.7326/M21-3498. Epub 2022 Feb 15.

DOI:10.7326/M21-3498

PMID:35157495

Abstract

BACKGROUND

Evidence about the association between types of oral anticoagulants and hazards of diabetes complications is limited in patients with atrial fibrillation (AF) and diabetes mellitus (DM).

OBJECTIVE

To compare the hazards of diabetes complications and mortality between patients with AF and DM receiving non-vitamin K antagonist oral anticoagulants (NOACs) and those receiving warfarin.

DESIGN

A retrospective cohort study.

SETTING

Nationwide data obtained from Taiwan's National Health Insurance Research Database.

PATIENTS

Patients with AF and DM receiving NOACs or warfarin between 2012 and 2017 in Taiwan were enrolled. Treatment groups were determined by patients' first initiation of oral anticoagulants.

MEASUREMENTS

Hazards of diabetes complications (macrovascular complications, microvascular complications, and glycemic emergency) and mortality in the NOAC and warfarin users were investigated with a target trial design. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HRs). Propensity score methods with stabilized inverse probability of treatment weighting were applied to balance potential confounders between treatment groups.

RESULTS

In total, 19 909 NOAC users and 10 300 warfarin users were included. Patients receiving NOACs had significantly lower hazards of developing macrovascular complications (HR, 0.84 [95% CI, 0.78 to 0.91]; < 0.001), microvascular complications (HR, 0.79 [CI, 0.73 to 0.85]; < 0.001), glycemic emergency (HR, 0.91 [CI, 0.83 to 0.99]; = 0.043), and mortality (HR, 0.78 [CI, 0.75 to 0.82]; < 0.001) than those receiving warfarin. Analyses with propensity score matching showed similar results. Several sensitivity analyses further supported the robustness of our findings.

LIMITATION

The claims-based data did not allow for detailed data on patients' lifestyles and laboratory examinations to be obtained.

CONCLUSION

Non-vitamin K antagonist oral anticoagulants were associated with lower hazards of diabetes complications and mortality than warfarin in patients with AF and DM.

PRIMARY FUNDING SOURCE

Hualien Tzu Chi Hospital.

摘要

背景

在心房颤动（AF）合并糖尿病（DM）患者中，关于口服抗凝剂类型与糖尿病并发症风险之间关联的证据有限。

目的

比较接受非维生素K拮抗剂口服抗凝剂（NOACs）和接受华法林治疗的AF合并DM患者发生糖尿病并发症和死亡的风险。

设计

一项回顾性队列研究。

研究地点

从台湾国民健康保险研究数据库获得的全国性数据。

患者

纳入2012年至2017年期间在台湾接受NOACs或华法林治疗的AF合并DM患者。治疗组由患者首次开始口服抗凝剂来确定。

测量指标

采用目标试验设计研究NOAC使用者和华法林使用者发生糖尿病并发症（大血管并发症、微血管并发症和血糖急症）和死亡的风险。使用特定病因的Cox比例风险模型来估计风险比（HRs）。应用具有稳定治疗权重逆概率的倾向评分方法来平衡治疗组之间的潜在混杂因素。

结果

总共纳入了19909名NOAC使用者和10300名华法林使用者。与接受华法林治疗的患者相比，接受NOACs治疗的患者发生大血管并发症（HR，0.84[95%CI，0.78至0.91]；P<0.001）、微血管并发症（HR，0.79[CI，0.73至0.85]；P<0.001）、血糖急症（HR，0.91[CI，0.83至0.99]；P = 0.043）和死亡（HR，0.78[CI，0.75至0.82]；P<0.001）的风险显著更低。倾向评分匹配分析显示了类似的结果。多项敏感性分析进一步支持了我们研究结果的稳健性。