LAUSR

Atrial fibrillation (AF) is associated with an increased risk of stroke, systemic embolism, and death. In the last decade, novel oral anticoagulants (NOACs) have emerged and are nowadays a key player in the anticoagulant armamentarium for patients with AF, slowly pushing out the good old warfarin. This is mainly due to their more predictable anticoagulant effect, fewer drug and food interactions, and the lack of need for routine monitoring. Moreover, in the 4 large phase‐III clinical trials with over 70 000 patients, NOACs (dabigatran in RE‐LY, rivaroxaban in ROCKET AF, apixaban in ARISTOTLE, and edoxaban in ENGAGE AF‐TIMI 48) had a favorable risk‐benefit profile, compared with warfarin. Patients with diabetes mellitus constitute a unique group among patients with AF, having a significantly higher risk of both thromboembolic and bleeding events. Indeed, diabetes is one of the components of the commonly used CHADS2 and CHA2DS2VASc risk scores in patients with AF. In the 4 phase‐III clinical trials examining the efficacy and safety of NOACs compared with warfarin in patients with AF, 23% to 40% of the patients had diabetes at baseline. In a prior meta‐analysis, NOACs, comparedwithwarfarin, reduced the rate of stroke or systemic embolism, intracranial hemorrhage, or death, with no significant interaction by diabetes status. In addition, there was no significant interaction in major bleeding by diabetes status, although the relative safety of NOACs was apparent more among patients without diabetes. Consistent results were observed in the meta‐analysis by Patti et al published in previous issue of Diabetes/Metabolism Research and Reviews, which engages specifically in diabetic patients from said 4 phase III trials. As expected, compared with patients without diabetes, patients with diabetes had higher rates of thromboembolic events and death. The efficacy of NOACs in patients with or without diabetes was similar. The value of meta‐analysis is to join data from several smaller trials that all have a similar outcome trend to intensify the statistical power. Indeed, this meta‐analysis showed that the trend toward better efficacy outcomes with NOACs became statistically significant upon pooling the data. There were