Abstract 15937: Comparison of Dabigatran versus Warfarin in Diabetic Patients with Atrial Fibrillation: Results from the RE-LY Trial

Abstract

BACKGROUND Diabetes mellitus (DM) is frequent among patients with atrial fibrillation (AF). The RE-LY trial permits a contemporary evaluation of comorbities, outcomes and the effectiveness of dabigatran in this important sub-group of patients with AF.

METHODS Patient characteristics and outcomes were compared between diabetic and non-diabetic patients in RE-LY and the relative efficacy of each dose of dabigatran versus warfarin was evaluated using an interaction p-value. RESULTS Of the 18113 patients in RE-LY, 4221 patients (23.3%) had DM. Patients with DM were younger (70.9 vs. 71.7 years, p<0.01), more likely to have hypertension (86.6% vs. 76.5%, p<0.01), coronary artery disease (37.4% vs. 24.9%, p<0.01) and peripheral vascular disease (5.6% vs. 3.2%, p<0.01). The median time in therapeutic range for warfarin-treated patients was 65% for diabetics compared to 68% for non-diabetics (p<0.001). Compared to non-diabetics, patients with DM had a higher risk of all important thrombotic and bleeding outcomes (p<0.001), except intracranial bleeding. However, the relative benefits of dabigatran compared to warfarin were similar in diabetic compared to non-diabetic patients (table; all p-values for interaction = n.s.). CONCLUSIONS AF patients with diabetes have a higher prevalence of cardiovascular diseases, poorer INR control and an increased risk of adverse outcomes. Compared to non-diabetics, they derive similar relative benefits of dabigatran over warfarin; however, they have a greater absolute reduction in embolic events.