Should we still be utilizing warfarin in the type 2 diabetic patient?

The frequency of non-valvular atrial fibrillation is increased by 40% in type 2 diabetic individuals and the thromboembolic risk associated with atrial fibrillation is increased by 79% compared with the non-diabetic individual with atrial fibrillation. Warfarin, the traditional anticoagulant used to prevent thromboembolism, is non-specific and affects several proteins outside the coagulation system. Decreasing the levels of matrix Gla protein entails an increase in coronary and renal artery calcification, which has the potential to increase cardiovascular events and accelerate decline in renal function. The direct-acting oral anticoagulants are specific, directly inhibiting either thrombin or factor Xa, and have been shown to be safer and more efficacious in studies of the type 2 diabetic patient.