ORal anticoaGulants in diAbetic and Nondiabetic patients with nOn-valvular atrial fibrillatioN (ORGANON)

• Published in: Journal of diabetes and its complications 2023-08, Vol.37 (8), p.108512-108512, Article 108512
• Main Authors: Derosa, Giuseppe, Rizzo, Manfredi, Brunetti, Natale Daniele, Raddino, Riccardo, Gavazzoni, Mara, Pasini, Gianfranco, Gaudio, Giovanni, Maggi, Antonio, D'Angelo, Angela, De Gennaro, Luisa, Maffioli, Pamela
• Format: Article
• Language: English
• Subjects: Administration, Oral; Anticoagulants; Anticoagulants - adverse effects; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Body mass index; Cardiac arrhythmia; Cholesterol; Creatinine; Dabigatran - adverse effects; Diabetes; Diabetes Mellitus - drug therapy; Diabetes Mellitus - epidemiology; DOACs; Drug dosages; Embolisms; Glucose; Hemoglobin; Hemorrhage - chemically induced; Hemorrhage - epidemiology; High density lipoprotein; Humans; Ischemia; Low density lipoprotein; Metabolic parameters; Plasma; Rivaroxaban - therapeutic use; Stroke; Stroke - epidemiology; Thromboembolism; Triglycerides; Warfarin
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2023.108512

Diabetes represents a pro-thrombotic condition. The primary objective was to evaluate the effects of Vitamin K Antagonist (VKA) compared to direct oral anticoagulants (DOACs) in diabetic and nondiabetic patients with non-valvular atrial fibrillation, newly diagnosed. The secondary objective was to evaluate the effects on the risk of bleeding. We enrolled 300 patients with newly diagnosed atrial fibrillation. One hundred and sixteen patients were taking warfarin, 31 acenocumarol, 22 dabigatran, 80 rivaroxaban, 34 apixaban, and 17 edoxaban. We evaluated: anthropometric parameters, glycated hemoglobin (HbA1c), fasting and post-prandial glucose (FPG, and PPG), lipid profile, Lp(a), small and dense low-density lipoprotein (SD-LDL), oxidized LDL (Ox-LDL), I-troponin (I-Tn), creatinine, transaminases, iron, red blood cells (RBC); hemoglobin (Hb), platelets (PLT), fibrinogen, D-dimer, anti-thrombin III, C-reactive protein (Hs-CRP), Metalloproteinases-2 (MMP-2), Metalloproteinases-9 (MMP-9), and incidence of bleeding. We did not record any differences among nondiabetic patients between VKA and DOACs. However, when we considered diabetic patients, we found a slight, but significant improvement of triglycerides and SD-LDL. As regards incidence of bleeding, minor bleeding was more frequent in VKA diabetic group compared to DOACs diabetic group; furthermore, the incidence of major bleeding was higher with VKA in nondiabetic and diabetic group, compared to patients with DOACs. Among DOACs, we recorded a higher incidence of bleeding (minor and major) with dabigatran compared to rivaroxaban, apixaban and edoxaban in nondiabetic and diabetic patients. DOACs seem to be metabolically favourable in diabetic patients. Regarding incidence of bleeding, DOACs with the exception of dabigatran, seem better than VKA in diabetic patients. •Diabetes represents a pro-thrombotic condition.•There is need for a correct anticoagulant approach in this setting of patients.•Direct oral anticoagulants seem to be metabolically favourable in diabetic patients.•Direct oral anticoagulants seem better than Vitamin K Antagonist in diabetic patients for bleeding incidence.