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Cardiovascular risks and bleeding with non-vitamin K antagonist oral anticoagulant versus warfarin in patients with type 2 diabetes: a tapered matching cohort study

Yu, Dahai; Zhao, Zhanzheng; Simmons, David

Cardiovascular risks and bleeding with non-vitamin K antagonist oral anticoagulant versus warfarin in patients with type 2 diabetes: a tapered matching cohort study Thumbnail


Authors

Zhanzheng Zhao

David Simmons



Abstract

Abstract

Background
We compared the risk of bleeding and cardiovascular disease (CVD) events between non-vitamin K antagonist oral anticoagulant (NOAC) and warfarin in people with type 2 diabetes (T2DM).

Methods
862 Incident NOAC users and 626 incident warfarin users with T2DM were identified from within 40 UK general practice (1/4/2017–30/9/2018). Outcomes included incident hospitalisation for bleeding, CVD and re-hospitalisation for CVD within 12 months since first anticoagulant prescription, identified from linked hospitalisation data. A tapered matching method was applied to form comparison cohorts: coarsened exact matching restricted the comparison to areas of sufficient overlap in missingness and characteristics: (i) demographic characteristics; (ii) clinical measurements; (iii) prior bleeding and CVD history; (iv) prescriptions with bleeding; (v) anti-hypertensive treatment(s); (vi) anti-diabetes treatment(s). Entropy balancing sequentially balanced NOAC and warfarin users on their distribution of (i–vi). Weighted logistic regression modelling estimated outcome odds ratios (ORs), using entropy balancing weights from steps i–vi.

Results
The 12-month ORs of bleeding with NOAC (n?=?582) vs matched/balanced warfarin (n?=?486) were 1.93 (95% confidence interval 0.97–3.84), 2.14 (1.03–4.44), 2.31 (1.10–4.85), 2.42 (1.14–5.14), 2.41 (1.12–5.18), and 2.51 (1.17–5.38) through steps i–vi. ORs for CVD re-hospitalisation was increased with NOAC treatment through steps i–vi: 2.21 (1.04–4.68), 2.13 (1.01–4.52), 2.47 (1.08–5.62), 2.46 (1.02–5.94), 2.51 (1.01–6.20), and 2.66 (1.02–6.94).

Conclusions
Incident NOAC use among T2DM is associated with increased risk of bleeding hospitalisation and CVD re-hospitalisation compared with incident warfarin use. For T2DM, caution is required in prescribing NOACs as first anticoagulant treatment. Further large-scale replication studies in external datasets are warranted.

Journal Article Type Article
Acceptance Date Oct 5, 2020
Online Publication Date Oct 10, 2020
Publication Date Oct 10, 2020
Publicly Available Date Mar 29, 2024
Journal Cardiovascular Diabetology
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Article Number 174
DOI https://doi.org/10.1186/s12933-020-01152-y
Keywords NOAC, Warfarin, Bleeding, Cardiovascular disease, Hospitalisation, Tapered matching, Non-vitamin K antagonist oral anticoagulants
Publisher URL http://doi.org/10.1186/s12933-020-01152-y

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