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Fracture risks among patients with atrial fibrillation receiving different oral anticoagulants: A real-world nationwide cohort study

European Heart Journal Feb 07, 2020

Huang HK, Liu PPS, Hsu JY, et al. - Researchers used Taiwan’s National Health Insurance Research Database to assess fracture risk among patients with atrial fibrillation (AF) managed with non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin in this real-world nationwide retrospective cohort analysis. Depending on the NOAC used (dabigatran, rivaroxaban, and apixaban), the sub-grouping of patients managed with NOACs was done. For hip, vertebral, and humerus/forearm/wrist fractures, the adjusted hazard ratios were calculated using Cox regression analysis, with a shared frailty model. A decreased fracture risk related to NOAC vs warfarin was observed in AF patients. Thus, considering NOACs rather than warfarin to reduce fracture risk was recommended if oral anticoagulants are indicated. In sub-analyses, reduced fracture risk was revealed in relation to each NOAC, namely dabigatran, rivaroxaban, and apixaban.
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