DOACs vs Warfarin: Which Is Best for Fracture Risk?

Use of direct oral anticoagulants (DOACs) is associated with lower fracture risk than warfarin in patients with atrial fibrillation (AF), according to the results of a recent study.

While osteoporotic fracture has been associated with anticoagulant treatment among patients with AF, whether the type of anticoagulation impacts this association is unclear.

For their population-based cohort study, the researchers examined data from a territory-wide electronic health record database from the Hong Kong Hospital Authority including 23,515 patients newly diagnosed with AF between 2010 and 2017 who received prescriptions for warfarin or DOAC.

Overall, 3241 of the patients were taking apixaban, 6867 were taking dabigatran, 3866 were taking rivaroxaban, and 9541 were taking warfarin. Over a median follow-up of 423 days, 401 fractures occurred. Of these, 53 occurred in patients taking apixaban, 95 in those taking dabigatran, 57 in those taking rivaroxaban, and 196 in those taking warfarin.

At 24 months, DOAC use was associated with lower risk for fracture compared with warfarin, with no differences observed in head-to-head comparisons between DOACs.

“These findings may help inform the benefit–risk assessment when choosing between anticoagulants,” the researchers concluded.

—Michael Potts

Reference:
Lau WCY, Cheung C, Man KKC, et al. Association between treatment with apixaban, dabigatran, rivaroxaban, or warfarin and risk for osteoporotic fractures among patients with atrial fibrillation. Published online May 19, 2020. Ann Intern Med. doi: 10.7326/M19-3671