(280) Warfarin and Sulfonylureas in Individuals with Type 2 Diabetes and Risk of Bleeding: A UK Population-Based Cohort Study

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 611

Presenting Author(s)

Hassan Hasan Alwafi, doctoral in Pharmacoepidemiology
– Assistant Professor, Umm Al-Qura University, Makkah, Saudi Arabia

Co-Author(s)

Abdallah Naser, MBA, PhD, BSc
– Assistant Professor, Isra University, Isra University, Jordan

Background: Patients with T2DM are likely to receive OACs for the management of cardiac comorbidities, such as AF where diabetes is a major therapeutic indication in the pharmacological management. Previous pre-clinical studies have reported a possible drug-drug interaction between warfarin and sulfonylureas through the displaced plasma protein binding and hepatic metabolism CY450. However, little is known about this association in real-world practice.

Objectives: To investigate the association of concurrent use of oral anticoagulants (OACs) and sulfonylureas and the risk of bleeding in individuals with type 2 diabetes mellitus (T2DM).

Methods: A retrospective cohort study was conducted between (2001-2017) using The Health Improvement Network (THIN) database. Individuals with T2DM who received OAC prescription and sulfonylureas were included. We compared the risk of bleeding with sulfonylureas and OACs using propensity score matching and Cox regression.

Results: A total of 418,613 individuals with T2DM were identified, of whom only 22,974 using warfarin and sulfonylureas were included for the analyses during the study period between 2001 and 2017. After matching, 9,918 individuals were included in each group. There were a total of 28,838.29 of concomitant exposure and, 1,548 bleeding events in the warfarin with sulfonylureas group (incidence rates = 53.6 per 1000 person-years), while users of warfarin only contributed to 30,068.24 person-years, during which 1,307 bleeding events were observed (incidence rates = 43.4 per 1000 person-years). The risk of bleeding was 12% higher in individuals with concomitant use of warfarin with sulfonylureas, compared to warfarin alone users (HR 1.12; 95% CI, 1.01 – 1.24, P= 0.028).

Conclusions: We provide real-world evidence of possible drug-drug interactions between warfarin and sulfonylureas. Future studies are needed to investigate the risk of bleeding and or hypoglycaemia among individuals using sulfonylureas and other oral anticoagulants.