Patients with type 2 diabetes (T2D) who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse cardiovascular and renal events than nondiabetic patients. However, limited evidence is available regarding the cardiovascular, renal, and limb outcomes of patients with T2D after PCI and who were treated with sodium–glucose cotransporter-2 inhibitors (SGLT2i). We compare the specified outcomes in patients with T2D after PCI who were treated with SGLT2i versus dipeptidyl peptidase-4 inhibitors (DPP4i). In this nationwide retrospective cohort study, we identified 4,248 and 37,037 consecutive patients with T2D who underwent PCI with SGLT2i and DPP4i, respectively, for May 1, 2016, to December 31, 2019. We used propensity score matching (PSM) to balance the covariates between study groups. After PSM, SGLT2i and DPP4i were associated with comparable risks of ischemic stroke, acute myocardial infarction, and lower limb amputation. However, SGLT2i was associated with significantly lower risks of heart failure hospitalization (HFH; 1.35% per year vs. 2.28% per year; hazard ratio [HR]: 0.60; P = 0.0001), coronary revascularization (2.33% per year vs. 3.36% per year; HR: 0.69; P = 0.0003), composite renal outcomes (0.10% per year vs. 1.05% per year; HR: 0.17; P < 0.0001), and all-cause mortality (2.27% per year vs. 3.80% per year, HR: 0.60; P < 0.0001) than were DPP4i. Our data indicated that SGLT2i, compared with DPP4i, were associated with lower risks of HFH, coronary revascularization, composite renal outcomes, and all-cause mortality for patients with T2D after PCI. Further randomized or prospective studies can investigate the effects of SGLT2i in patients with T2D after PCI.

Bleeding risk with dabigatran, rivaroxaban, warfarin, and antiplatelet agent in asians with non-valvular atrial fibrillation Bleeding risk with dabigatran, rivaroxaban, warfarin, and antiplatelet agent in asians with non-valvular atrial fibrillation

Objective Patients with hyperthyroidism were excluded from randomized clinical trials of direct oral anticoagulants(DOACs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Methods We performed a nationwide retrospective cohort study using data from the Taiwan National Health Insurance Research Database. We enrolled 3,213 and 1,181 NVAF patients with hyperthyroidism taking DOACs and warfarin, respectively, from June 1, 2012 to December 31, 2017. We also enrolled 53,591 and 16,564 NVAF patients without hyperthyroidism taking DOACs and warfarin, respectively. We used propensity score-based stabilized weights (PSSWs) to balance covariates across the study groups. We also used 1:4 matching on both taking DOACs, with (n=3,213) and without hyperthyroidism (n=12,852); and both taking warfarin, with (n=1,181) and without hyperthyroidism (n=4,724). Results After PSSW, DOAC had a comparable risk of ischemic stroke/systemic embolism (IS/SE) and a lower risk of major bleeding (hazard ratio (HR):0.65; [95% confidential interval (CI):0.44-0.96]; P=0.0295) than warfarin among patients with hyperthyroidism. There were comparable risks of IS/SE and major bleeding between those patients with and without hyperthyroidism. However, patients taking warfarin with hyperthyroidism had a lower risk of IS/SE than those without hyperthyroidism (HR:0.61; [95%CI:0.43-0.86]; P=0.0050). Conclusion Among NVAF Asian patients with concomitant hyperthyroidism, DOACs may be an effective and safer alternative to warfarin. Thromboprophylaxis with DOACs may be considered for such patients, and it is important to validate this finding in further prospective study.