Safety and Efficacy of Conventional Antithrombotics versus Direct Oral Anticoagulants in Diabetic Patients: A Jordanian-Based Cross-Sectional Study

The prevalence of diabetes mellitus (DM) is rapidly improving and leads to metabolic disease and severe complications. This study assessed the safety and efficacy of antithrombotic in patients with diabetes, and their complications and coexisting atrial fibrillation (AF) risk. It compared the effectiveness and safety of direct oral anticoagulants (DOACs) to conventional oral antithrombotic (OAT) medications (warfarin and aspirin) concerning anti-glycemic agents. This is a cross-sectional study. Primary data was collected through a questionnaire when interviewing the patients, followed by a systemic review using clinical scores such as the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or transient ischaemic attack (TIA) or thromboembolism, vascular disease, age, sex category (CHA2DS2-VASc), and Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International normalized ratio (INR), Elderly, Drugs/Alcohol Concomitantly (HAS-BLED). Secondary data collection involved a thorough review of existing research and literature. Significant interactions were observed between antithrombotic and anti-glycemic agents. Warfarin combined with sulfonylurea or metformin posed moderate to severe hypoglycemic risks. Insulin has a weak interaction with warfarin, reflecting a low hypoglycemia risk. Aspirin showed a moderate risk only with sulfonylurea. Warfarin and aspirin are associated with a higher risk of bleeding with sulfonylurea but minimal risk with metformin and insulin. OATs have a 60.8% risk of hypoglycemia and a 55.1% risk of bleeding. DOAC showed strong correlations in reducing stroke and hypoglycemia, (Pearson correlation coefficient [PCC] is 0.969), and strong correlation in reducing bleeding (PCC is 0.769). These findings suggest that DOACs may offer a safer alternative to OATs in patients with diabetes and AF.