Key result
NOACs linked to a lower risk of any and osteoporotic fractures versus warfarin.
Why the study?
The comparative effects of NOACs versus warfarin on fracture risk in patients with AF remained controversial.
Do non-vitamin K antagonist oral anticoagulants reduce the risk of fractures compared to warfarin in patients with atrial fibrillation?
Meta-Analysis
Do non-vitamin K antagonist oral anticoagulants reduce the risk of fractures compared to warfarin in patients with atrial fibrillation?
p-value: p=0.001
In patients with atrial fibrillation, NOACs are associated with a significantly lower risk of any fracture and osteoporotic fracture compared to warfarin.
Supports NOAC preference over warfarin in AF for fracture-prone patients; extends meta-analytic safety data beyond stroke prevention.
BACKGROUND: warfarin in patients with atrial fibrillation (AF) remain controversial. METHODS: PubMed, Cochrane Library, EMBASE, Clinical Trials.gov databases for RCTs, and cohort studies were systematically searched from inception to 10 June 2021. RESULTS: = 0.001). No significant difference was observed in the hip or pelvic fracture, vertebral fracture, extremity fracture, wrist fracture, femoral neck fracture, and ankle fracture. In subgroup analyses based on several aspects, NOACs were associated with a significant reduction in any fracture (standard dosage NOACs, cohort studies, elderly patients, rivaroxaban in RCTs, dabigatran, rivaroxaban, and apixaban in cohort studies), in the hip/pelvic fracture (follow-up time ≤1 year, cohort studies), and osteoporotic fracture (cohort studies). CONCLUSION: NOACs were associated with a significantly lower risk of any fracture and osteoporotic fracture compared to warfarin. This benefit was also observed in specific NOACs types of dabigatran, rivaroxaban, and apixaban. However, whether NOACs had a less fracture risk than warfarin on the other risk of fractures was still uncertain.
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Yang et al. (2022) conducted a meta-analysis in atrial fibrillation. Non-vitamin K antagonist oral anticoagulants (NOACs) vs. warfarin was evaluated on any fracture and osteoporotic fracture (p=0.001). Non-vitamin K antagonist oral anticoagulants were associated with a significantly lower risk of any fracture and osteoporotic fracture compared to warfarin (P=0.001).
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