File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Association Between Treatment With Apixaban, Dabigatran, Rivaroxaban, or Warfarin and Risk for Osteoporotic Fractures Among Patients With Atrial Fibrillation: A Population-Based Cohort Study

TitleAssociation Between Treatment With Apixaban, Dabigatran, Rivaroxaban, or Warfarin and Risk for Osteoporotic Fractures Among Patients With Atrial Fibrillation: A Population-Based Cohort Study
Authors
KeywordsAdverse events
Hospitals
Osteoporosis
Cohort studies
Research design
Issue Date2020
PublisherAmerican College of Physicians. The Journal's web site is located at http://www.annals.org
Citation
Annals of Internal Medicine, 2020, v. 173 n. 1, p. 1-9 How to Cite?
AbstractBackground: It is unclear whether anticoagulant type is associated with the risk for osteoporotic fracture, a deleterious complication of anticoagulants among patients with atrial fibrillation (AF). Objective: To compare the risk for osteoporotic fracture between anticoagulants. Design: Population-based cohort study. Setting: Territory-wide electronic health record database of the Hong Kong Hospital Authority. Participants: Patients newly diagnosed with AF between 2010 and 2017 who received a new prescription for warfarin or a direct oral anticoagulant (DOAC) (apixaban, dabigatran, or rivaroxaban). Follow-up ended on 31 December 2018. Measurements: Osteoporotic hip and vertebral fractures in anticoagulant users were compared using propensity score–weighted cumulative incidence differences (CIDs). Results: There were 23 515 patients identified (3241 apixaban users, 6867 dabigatran users, 3866 rivaroxaban users, and 9541 warfarin users). Overall mean age was 74.4 years (SD, 10.8), ranging from 73.1 years (warfarin) to 77.9 years (apixaban). Over a median follow-up of 423 days, 401 fractures were identified (crude event number [weighted rate per 100 patient-years]: apixaban, 53 [0.82]; dabigatran, 95 [0.76]; rivaroxaban, 57 [0.67]; and warfarin, 196 [1.11]). After 24-month follow-up, DOAC use was associated with a lower risk for fracture than warfarin use (apixaban CID, −0.88% [95% CI, −1.66% to −0.21%]; dabigatran CID, −0.81% [CI, −1.34% to −0.23%]; and rivaroxaban CID, −1.13% [CI, −1.67% to −0.53%]). No differences were seen in all head-to-head comparisons between DOACs at 24 months (apixaban vs. dabigatran CID, −0.06% [CI, −0.69% to 0.49%]; rivaroxaban vs. dabigatran CID, −0.32% [CI, −0.84% to 0.18%]; and rivaroxaban vs. apixaban CID, −0.25% [CI, −0.86% to 0.40%]). Limitation: Residual confounding is possible. Conclusion: Among patients with AF, DOAC 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 DOAC. These findings may help inform the benefit–risk assessment when choosing between anticoagulants. Primary Funding Source: The University of Hong Kong and University College London Strategic Partnership Fund.
Persistent Identifierhttp://hdl.handle.net/10722/284835
ISSN
2019 Impact Factor: 21.317
2015 SCImago Journal Rankings: 5.378

 

DC FieldValueLanguage
dc.contributor.authorLau, CY-
dc.contributor.authorCheung, CL-
dc.contributor.authorMan, KKC-
dc.contributor.authorChan, EW-
dc.contributor.authorSing, CW-
dc.contributor.authorLip, GYH-
dc.contributor.authorSiu, CW-
dc.contributor.authorLam, JKY-
dc.contributor.authorLee, ACH-
dc.contributor.authorWong, ICK-
dc.date.accessioned2020-08-07T09:03:15Z-
dc.date.available2020-08-07T09:03:15Z-
dc.date.issued2020-
dc.identifier.citationAnnals of Internal Medicine, 2020, v. 173 n. 1, p. 1-9-
dc.identifier.issn0003-4819-
dc.identifier.urihttp://hdl.handle.net/10722/284835-
dc.description.abstractBackground: It is unclear whether anticoagulant type is associated with the risk for osteoporotic fracture, a deleterious complication of anticoagulants among patients with atrial fibrillation (AF). Objective: To compare the risk for osteoporotic fracture between anticoagulants. Design: Population-based cohort study. Setting: Territory-wide electronic health record database of the Hong Kong Hospital Authority. Participants: Patients newly diagnosed with AF between 2010 and 2017 who received a new prescription for warfarin or a direct oral anticoagulant (DOAC) (apixaban, dabigatran, or rivaroxaban). Follow-up ended on 31 December 2018. Measurements: Osteoporotic hip and vertebral fractures in anticoagulant users were compared using propensity score–weighted cumulative incidence differences (CIDs). Results: There were 23 515 patients identified (3241 apixaban users, 6867 dabigatran users, 3866 rivaroxaban users, and 9541 warfarin users). Overall mean age was 74.4 years (SD, 10.8), ranging from 73.1 years (warfarin) to 77.9 years (apixaban). Over a median follow-up of 423 days, 401 fractures were identified (crude event number [weighted rate per 100 patient-years]: apixaban, 53 [0.82]; dabigatran, 95 [0.76]; rivaroxaban, 57 [0.67]; and warfarin, 196 [1.11]). After 24-month follow-up, DOAC use was associated with a lower risk for fracture than warfarin use (apixaban CID, −0.88% [95% CI, −1.66% to −0.21%]; dabigatran CID, −0.81% [CI, −1.34% to −0.23%]; and rivaroxaban CID, −1.13% [CI, −1.67% to −0.53%]). No differences were seen in all head-to-head comparisons between DOACs at 24 months (apixaban vs. dabigatran CID, −0.06% [CI, −0.69% to 0.49%]; rivaroxaban vs. dabigatran CID, −0.32% [CI, −0.84% to 0.18%]; and rivaroxaban vs. apixaban CID, −0.25% [CI, −0.86% to 0.40%]). Limitation: Residual confounding is possible. Conclusion: Among patients with AF, DOAC 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 DOAC. These findings may help inform the benefit–risk assessment when choosing between anticoagulants. Primary Funding Source: The University of Hong Kong and University College London Strategic Partnership Fund.-
dc.languageeng-
dc.publisherAmerican College of Physicians. The Journal's web site is located at http://www.annals.org-
dc.relation.ispartofAnnals of Internal Medicine-
dc.subjectAdverse events-
dc.subjectHospitals-
dc.subjectOsteoporosis-
dc.subjectCohort studies-
dc.subjectResearch design-
dc.titleAssociation Between Treatment With Apixaban, Dabigatran, Rivaroxaban, or Warfarin and Risk for Osteoporotic Fractures Among Patients With Atrial Fibrillation: A Population-Based Cohort Study-
dc.typeArticle-
dc.identifier.emailLau, CY: wallisy@hku.hk-
dc.identifier.emailCheung, CL: lung1212@hku.hk-
dc.identifier.emailMan, KKC: mkckth@hku.hk-
dc.identifier.emailChan, EW: ewchan@hku.hk-
dc.identifier.emailSing, CW: cwsing@connect.hku.hk-
dc.identifier.emailSiu, CW: cwdsiu@hkucc.hku.hk-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.authorityCheung, CL=rp01749-
dc.identifier.authorityChan, EW=rp01587-
dc.identifier.authoritySiu, CW=rp00534-
dc.identifier.authorityWong, ICK=rp01480-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.7326/M19-3671-
dc.identifier.pmid32423351-
dc.identifier.scopuseid_2-s2.0-85086665481-
dc.identifier.hkuros311616-
dc.identifier.volume173-
dc.identifier.issue1-
dc.identifier.spage1-
dc.identifier.epage9-
dc.publisher.placeUnited States-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats