Abstract
BackgroundWe aimed to investigate the comparative risk of fracture among patients with atrial fibrillation (AF) treated with warfarin or non-vitamin K antagonist oral anticoagulants (NOACs).MethodsUsing the Korean National Health Insurance Service database, patients with AF who received a prescription for apixaban, dabigatran, rivaroxaban, or warfarin between 2013 and 2016 were included. Risk of major fractures (osteoporotic hip, vertebral, or pelvic fractures) were compared using inverse probability of treatment weighting.ResultsThere were 70,481 patients identified (41.3% women; mean [SD] age 70.5 [11.3] years); 16,992 apixaban, 22,514 dabigatran, 27,998 rivaroxaban, and 29,390 warfarin users. During a median follow-up of 390 days, 2412 major fractures occurred with weighted incidences per 100 patient-years of 2.56 for apixaban, 2.39 for dabigatran, 2.78 for rivaroxaban, and 3.43 for warfarin. NOAC use was associated with a lower risk for fracture than warfarin use: HR 0.70 (95% confidence interval [CI] 0.57–0.86) for apixaban, HR 0.69 (95% CI 0.60–0.78) for dabigatran, and HR 0.79 (95% CI 0.70–0.90) for rivaroxaban. In head-to-head comparisons between NOACs, there was no significant difference between apixaban and dabigatran. Rivaroxaban was associated with a higher risk for fracture than dabigatran (HR 1.15, 95% CI 1.02–1.31).ConclusionIn patients with AF, NOAC use may result in a lower risk for osteoporotic fracture compared with warfarin use. Fracture risk does not seem to be altered by the choice of NOAC type, except for rivaroxaban. These associations may help inform benefit–risk assessments when choosing between the different anticoagulant types.
Highlights
Osteoporotic fractures are associated with high mortality and reduced quality of life in an elderly population [1]
Non-vitamin K antagonist oral anticoagulant (NOAC), rivaroxaban use was associated with a higher risk for fractures than dabigatran use (HR 1.15, 95% Confidence interval (CI) 1.02–1.31) (Table 3)
The E-value in this study suggested that a rare unmeasured confounder could explain our observed associations of NOAC use with lower fracture risk compared with warfarin only
Summary
Osteoporotic fractures are associated with high mortality and reduced quality of life in an elderly population [1]. Preclinical studies have shown that several vitamin K–dependent proteins, such as matrix Gla protein and osteopontin, play a role in bone metabolism [9], and this has led to concerns that warfarin may increase the risk for osteoporotic fracture. These results correlate with clinical findings that propose a connection between warfarin and an increased risk of osteoporotic fractures [8,9,10,11, 14,15,16,17]. We aimed to investigate the comparative risk of fracture among patients with atrial fibrillation (AF) treated with warfarin or non-vitamin K antagonist oral anticoagulants (NOACs)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
