Non-vitamin K antagonist oral anticoagulants associated with lower risks of bone fracture, Finds study

Evidence on the differences in fracture risk associated with non‐vitamin K antagonist oral anticoagulants (NOAC) and warfarin is inconsistent and inconclusive.

Therefore, Huei‐Kai Huang and colleagues from the Institute of Epidemiology and Preventive Medicine, , College of Public Health, , National Taiwan University, Taipei, Taiwan conducted the a systematic review and meta‐analysis to assess the fracture risk associated with NOACs and warfarin.

The authors 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. A total of 29 studies (5 cohort studies and 24 randomized controlled trials) with 388 209 patients were included for the present study.

The results seen were-

1. 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 (I²=38.9%).
2. 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).
3. 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).
4. 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, the researchers revealed.

Hence, it was concluded that "compared with warfarin, NOACs are associated with lower risks of bone fracture."