Hip fracture risk in patients with atrial fibrillation receiving oral anticoagulants: a meta-analysis based on current observational studies

Huang, Huei‐Kai; Yeh, Jih‐I; Loh, Ching‐Hui

doi:10.1093/eurheartj/ehaa361

Cited by 3 publications

(4 citation statements)

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“…This result is consistent with a recent meta-analysis including three observational studies conducted by Huang et al. [ 15 ]. The pooled results also suggest that the risk of vertebral fractures is lower among the DOAC users when compared with the warfarin users with minimal heterogeneity ( I 2 : 0.0%).…”

Section: Discussionsupporting

confidence: 93%

“…Recently, Huang et al. [ 15 ] performed a meta-analysis including three current observational studies and suggest that the DOAC use has a lower risk of hip fractures compared with the warfarin use, which is in line with our result indicating the association between the DOAC use, rather than the warfarin use, and the lower risk of hip fractures. However, it is worth noting that the prescription of whether DOACs or warfarin in older patients with AF should generally depend on the evaluation of the risk of ischemic stroke, hemorrhage, monitoring and affordability rather than the risk of osteoporotic fractures [ 36 ].…”

Section: Discussionsupporting

confidence: 91%

“…However, evidence on the difference in fracture risks for AF patients prescribed DOACs or warfarin is still limited and controversial. Recently, one meta-analysis including three current observational studies shows that DOAC use is associated with a lower risk of hip fractures compared with warfarin use [ 15 ]. Another meta-analysis including 12 randomised controlled trials (RCTs) also demonstrates a relatively lower risk of fractures in DOAC users compared with that in warfarin users, although the study population included not only patients with AF but also those with venous thromboembolism (VTE) and pulmonary embolism (PE) [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review

Xie¹,

Liu²,

Li³

et al. 2022

Age and Ageing

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Aims evidence on the difference in fracture risks for patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) versus warfarin remains controversial. We aim to compare the fracture risks between the DOAC and warfarin prescriptions among the AF patients. Methods and Results we systematically searched PubMed, EMBASE, the Cochrane Library and Web of Science up to 19 April 2021 for relevant studies. And the observational studies regarding the relationship between the DAOC versus warfarin prescriptions and fracture risks among the patients with AF were included in this meta-analysis. Two investigators independently screened the articles and extracted the relevant data. A random- or fixed-effect model was applied to calculate the pooled hazard ratio/relative ratios with 95% confidence intervals of fracture risks associated with the DOAC and warfarin prescriptions. Six studies comprising 351,208 patients and 9,424 fractures were included in this meta-analysis. Overall, the AF patients treated with DOACs tend to present a lower risk of any fracture compared with those treated with warfarin (relative ratio: 0.82, 95% confidence interval (CI): 0.74–0.91). Sub-analyses for each individual DOAC indicate that apixaban and rivaroxan are associated with lower risk of any fracture compared with warfarin (HR: 0.75, 95% CI: 0.60–0.92, and HR: 0.79, 95% CI: 0.71–0.88, respectively). Conclusion this meta-analysis suggests that DOAC users have a lower risk of fractures than the warfarin users. The results of this study may provide optimal anticoagulation opportunities for AF patients with high fracture risk factors.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review

Xie¹,

Liu²,

Li³

et al. 2022

Age and Ageing

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“…For instance, Lau et al concluded that the use of dabigatran compared with warfarin was associated with a lower risk of osteoporotic fractures in patients with AF (36). Recently, a meta-analysis conducted by Huang et al indicated that DOAC users tended to have a incidence of hip fractures than warfarin users (37). Our previous meta-analysis also suggested that, among AF patients, DOAC users experienced a lower risk of fracture than warfarin users, especially among those patients with a history of osteoporosis (22).…”

Section: Discussionmentioning

confidence: 53%

Risk of osteoporosis in patients treated with direct oral anticoagulants vs. warfarin: an analysis of observational studies

Liu,

Xie,

et al. 2023

Front. Endocrinol.

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AimsEvidence on the association between the risk of new-onset osteoporosis and oral anticoagulants remains controversial. We aimed to compare the risk of osteoporosis associated with the use of direct oral anticoagulants (DOACs) with that associated with warfarin use.MethodsStudies published up to 15 March 2023 that investigated the association between the use of DOACs and warfarin and the incidence of osteoporosis were identified by online searches in PubMed, Embase, the Cochrane Library, and Web of Science conducted by two independent investigators. Random-effects or fixed-effect models were employed to synthesize hazard ratios (HRs)/relative ratios (RRs) with 95% confidence intervals (CIs) for estimating the risk of osteoporosis correlated with DOAC and warfarin prescriptions (PROSPERO No. CRD42023401199).ResultsOur meta-analysis ultimately included four studies involving 74,338 patients. The results suggested that DOAC use was associated with a significantly lower incidence of new-onset osteoporosis than warfarin use (pooled HR: 0.71, 95% CI: 0.57 to 0.88, p < 0.001, I2: 85.1%). Subanalyses revealed that rivaroxaban was associated with a lower risk of osteoporosis than both warfarin and dabigatran. In addition, DOACs were associated with a lower risk of developing osteoporosis than warfarin in both male and female patients, in patients with atrial fibrillation (AF), and in patients who underwent therapy for > 365 days.ConclusionDOAC users experienced a lower incidence of osteoporosis than warfarin users. This study may give us insight into safe anticoagulation strategies for patients who are at high risk of developing osteoporosis.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42023401199.

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Fracture Risks in Patients Treated With Different Oral Anticoagulants: A Systematic Review and Meta‐Analysis

Huang

Peng

Lin

et al. 2021

JAHA

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Background Evidence on the differences in fracture risk associated with non‐vitamin K antagonist oral anticoagulants (NOAC) and warfarin is inconsistent and inconclusive. We conducted a systematic review and meta‐analysis to assess the fracture risk associated with NOACs and warfarin. Methods and Results We searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov from inception until May 19, 2020. We included studies presenting measurements (regardless of primary/secondary/tertiary/safety outcomes) for any fracture in both NOAC and warfarin users. Two or more reviewers independently screened relevant articles, extracted data, and performed quality assessments. Data were retrieved to synthesize the pooled relative risk (RR) of fractures associated with NOACs versus warfarin. Random‐effects models were used for data synthesis. We included 29 studies (5 cohort studies and 24 randomized controlled trials) with 388 209 patients. Patients treated with NOACs had lower risks of fracture than those treated with warfarin (pooled RR, 0.84; 95% CI, 0.77–0.91; P <0.001) with low heterogeneity ( I 2 =38.9%). NOACs were also associated with significantly lower risks of hip fracture than warfarin (pooled RR, 0.89; 95% CI, 0.81–0.98; P =0.023). A nonsignificant trend of lower vertebral fracture risk in NOAC users was also observed (pooled RR, 0.74; 95% CI, 0.54–1.01; P =0.061). Subgroup analyses for individual NOACs demonstrated that dabigatran, rivaroxaban, and apixaban were significantly associated with lower fracture risks. Furthermore, the data synthesis results from randomized controlled trials and real‐world cohort studies were quite consistent, indicating the robustness of our findings. Conclusions Compared with warfarin, NOACs are associated with lower risks of bone fracture.

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Hip fracture risk in patients with atrial fibrillation receiving oral anticoagulants: a meta-analysis based on current observational studies

Cited by 3 publications

References 5 publications

Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review

Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review

Risk of osteoporosis in patients treated with direct oral anticoagulants vs. warfarin: an analysis of observational studies

Fracture Risks in Patients Treated With Different Oral Anticoagulants: A Systematic Review and Meta‐Analysis

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