Patients with diabetes have a higher risk of nonvalvular atrial fibrillation (NVAF), cerebral embolisms and anticoagulant-related intracranial bleeding when compared to nondiabetic patients. Non-vitamin K oral anticoagulants (NOACs) are progressively replacing antivitamin K agents among patients with NVAF. They are as efficacious as warfarin to reduce the risk of cerebral and systemic embolisms while reducing the risk of both severe and cerebral hemorrhages. Four studies reported results of prespecified subanalyses that compared results of efficacy and safety of NOACs (dabigatran, rivaroxaban, apixaban, edoxaban) in patients with and without diabetes, overall with similar results in both subgroups. ENGAGE AF-TIMI 48 is the only trial that reported a significant reduction of severe hemorrhages with edoxaban compared with warfarin in diabetic patients with NVAF.
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