Ophthalmic complications in patients with nonvalvular atrial fibrillation and type 2 diabetes prescribed rivaroxaban or warfarin

Abstract

INTRODUCTION: Patients with type 2 diabetes (T2D) are at an increased risk of ophthalmic complications compared to those without. Ophthalmic complications in T2D patients with comorbid nonvalvular atrial fibrillation (NVAF) may include ophthalmic bleeding and/or diabetic retinopathy. PURPOSE: We sought to evaluate ophthalmic complications in patients with NVAF and T2D prescribed rivaroxaban or warfarin for stroke prevention. METHOD(S): Optum de-identified electronic health record (EHR) data from 11/2010-3/2020 were utilized. Adults with NVAF and T2D, newly started on rivaroxaban or warfarin and with >=12 months of prior EHR activity were included. Patients were excluded if they received any oral anticoagulation in the prior 12 months, had valvular disease or pre-existing diabetic retinopathy. Our primary outcome was the incidence rate of any ophthalmic complication including non-traumatic bleeding (choroidal, intraocular, retinal, vitreous) or diabetic retinopathy. Ophthalmic bleeds typically associated with trauma (hyphema, orbital) were excluded from our outcomes. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using propensity score-overlap weighted Cox regression. RESULT(S): We included 26,537 rivaroxaban and 61,690 warfarin patients. The average age of patients was 69 +/- 9 years, CHA2DS2VASc score was 4.1 +/- 1.5 and HASBLED 1.5 +/- 0.9. Thirty-two percent of patients had an a1c >=7.0 and 16% an a1c>=8.0. Rivaroxaban was associated with a 15% (95%CI = 8-21%) relative hazard reduction of any ophthalmic complication (incidence rate = 1.25 vs. 1.46%/year) (Table), driven by reductions in both ophthalmic bleeding (HR = 0.80) and diabetic retinopathy (HR = 0.85). CONCLUSION(S): Rivaroxaban was associated with a reduction in ophthalmic complications compared to warfarin.