Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis

Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis

Abstract Aims  Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs an...

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Veröffentlicht in:Europace (London, England) England), 2021-01, Vol.23 (1), p.39-48
Hauptverfasser: Mongkhon, Pajaree, Fanning, Laura, Wong, Kirstie H T W, Man, Kenneth K C, Wong, Ian C K, Lau, Wallis C Y
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container_issue 1
container_start_page 39
container_title Europace (London, England)
container_volume 23
creator Mongkhon, Pajaree
Fanning, Laura
Wong, Kirstie H T W
Man, Kenneth K C
Wong, Ian C K
Lau, Wallis C Y
description Abstract Aims  Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. Methods and results  PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian–Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75–0.92, P 
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This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. Methods and results  PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian–Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75–0.92, P &lt; 0.001, I2 = 73.0%]. When comparing individual NOAC to VKAs, a statistically significant lower risk of any fractures was found for rivaroxaban (pooled RR = 0.79, 95% CI: 0.71–0.88, P &lt; 0.001, I2 = 55.2%) and apixaban (pooled RR = 0.75, 95% CI: 0.60–0.92, P = 0.007, I2 = 54.5%), but not dabigatran (pooled RR = 0.87, 95% CI: 0.74–1.01, P = 0.061, I2 = 74.6%). No differences were observed in all head-to-head comparisons between NOACs. Conclusion  This large meta-analysis suggests that NOACs use was associated with a lower risk of fractures compared with VKAs. Fracture risks were similar between NOACs. These findings may help inform the optimal anticoagulant choice for patients with AF at high risk of fracture.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euaa242</identifier><identifier>PMID: 33085751</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>Europace (London, England), 2021-01, Vol.23 (1), p.39-48</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. 2020</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-63de7981ea173a003a8fdfc719c60899fd924445b8bef6183547e3b17417e4e23</citedby><cites>FETCH-LOGICAL-c377t-63de7981ea173a003a8fdfc719c60899fd924445b8bef6183547e3b17417e4e23</cites><orcidid>0000-0002-3050-1557</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1598,27901,27902</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/europace/euaa242$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33085751$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mongkhon, Pajaree</creatorcontrib><creatorcontrib>Fanning, Laura</creatorcontrib><creatorcontrib>Wong, Kirstie H T W</creatorcontrib><creatorcontrib>Man, Kenneth K C</creatorcontrib><creatorcontrib>Wong, Ian C K</creatorcontrib><creatorcontrib>Lau, Wallis C Y</creatorcontrib><title>Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract Aims  Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. Methods and results  PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian–Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75–0.92, P &lt; 0.001, I2 = 73.0%]. When comparing individual NOAC to VKAs, a statistically significant lower risk of any fractures was found for rivaroxaban (pooled RR = 0.79, 95% CI: 0.71–0.88, P &lt; 0.001, I2 = 55.2%) and apixaban (pooled RR = 0.75, 95% CI: 0.60–0.92, P = 0.007, I2 = 54.5%), but not dabigatran (pooled RR = 0.87, 95% CI: 0.74–1.01, P = 0.061, I2 = 74.6%). No differences were observed in all head-to-head comparisons between NOACs. Conclusion  This large meta-analysis suggests that NOACs use was associated with a lower risk of fractures compared with VKAs. Fracture risks were similar between NOACs. These findings may help inform the optimal anticoagulant choice for patients with AF at high risk of fracture.</description><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkE1Lw0AQhhdRbK3ePckeBYnuV7JZb1L8wqIXvRomyUSiSTbuJpX-e1fbevU078AzL8xDyDFn55wZeYGjsz0UGAKAUGKHTHksRSSYEbshM2OimAszIQfevzPGtDDxPplIydJYx3xKXh9tFy3rAdq6ow_UOmgodENdWHgbm5B8WEvqav9BbUUrB8UwOvSXFKhf-QFbCDB1uKzx6xdtcYAIOmhWvvaHZK-CxuPRZs7Iy8318_wuWjzd3s-vFlEhtR6iRJaoTcoRuJbAmIS0KqtCc1MkLDWmKo1QSsV5mmOV8FTGSqPMuVZco0IhZ-R03ds7-zmiH7K29gU24QO0o8-EimWSJkzKgLI1WjjrvcMq613dgltlnGU_VrOt1WxjNZycbNrHvMXy72CrMQBna8CO_f913-Feha8</recordid><startdate>20210127</startdate><enddate>20210127</enddate><creator>Mongkhon, Pajaree</creator><creator>Fanning, Laura</creator><creator>Wong, Kirstie H T W</creator><creator>Man, Kenneth K C</creator><creator>Wong, Ian C K</creator><creator>Lau, Wallis C Y</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3050-1557</orcidid></search><sort><creationdate>20210127</creationdate><title>Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis</title><author>Mongkhon, Pajaree ; Fanning, Laura ; Wong, Kirstie H T W ; Man, Kenneth K C ; Wong, Ian C K ; Lau, Wallis C Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-63de7981ea173a003a8fdfc719c60899fd924445b8bef6183547e3b17417e4e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mongkhon, Pajaree</creatorcontrib><creatorcontrib>Fanning, Laura</creatorcontrib><creatorcontrib>Wong, Kirstie H T W</creatorcontrib><creatorcontrib>Man, Kenneth K C</creatorcontrib><creatorcontrib>Wong, Ian C K</creatorcontrib><creatorcontrib>Lau, Wallis C Y</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Mongkhon, Pajaree</au><au>Fanning, Laura</au><au>Wong, Kirstie H T W</au><au>Man, Kenneth K C</au><au>Wong, Ian C K</au><au>Lau, Wallis C Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2021-01-27</date><risdate>2021</risdate><volume>23</volume><issue>1</issue><spage>39</spage><epage>48</epage><pages>39-48</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract Aims  Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. Methods and results  PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian–Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75–0.92, P &lt; 0.001, I2 = 73.0%]. When comparing individual NOAC to VKAs, a statistically significant lower risk of any fractures was found for rivaroxaban (pooled RR = 0.79, 95% CI: 0.71–0.88, P &lt; 0.001, I2 = 55.2%) and apixaban (pooled RR = 0.75, 95% CI: 0.60–0.92, P = 0.007, I2 = 54.5%), but not dabigatran (pooled RR = 0.87, 95% CI: 0.74–1.01, P = 0.061, I2 = 74.6%). No differences were observed in all head-to-head comparisons between NOACs. Conclusion  This large meta-analysis suggests that NOACs use was associated with a lower risk of fractures compared with VKAs. Fracture risks were similar between NOACs. These findings may help inform the optimal anticoagulant choice for patients with AF at high risk of fracture.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>33085751</pmid><doi>10.1093/europace/euaa242</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3050-1557</orcidid><oa>free_for_read</oa></addata></record>
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title Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis
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