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Association between Dabigatran vs Warfarin and Risk of Osteoporotic Fractures among Patients with Nonvalvular Atrial Fibrillation

Wallis, CY; Chan, EW; Cheung, CL; Sing, CW; Man, KKC; Lip, GYH; Siu, CW; ... Wong, ICK; + view all (2017) Association between Dabigatran vs Warfarin and Risk of Osteoporotic Fractures among Patients with Nonvalvular Atrial Fibrillation. JAMA - Journal of the American Medical Association , 317 (11) pp. 1151-1158. 10.1001/jama.2017.1363. Green open access

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Abstract

IMPORTANCE: The risk of osteoporotic fracture with dabigatran use in patients with nonvalvular atrial fibrillation (NVAF) is unknown. OBJECTIVE: To investigate the risk of osteoporotic fracture with dabigatran vs warfarin in patients with NVAF. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study using a population-wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with NVAF from 2010 through 2014 and prescribed dabigatran or warfarin were matched by propensity score at a 1:2 ratio with follow-up until July 31, 2016. EXPOSURES: Dabigatran or warfarin use during the study period. MAIN OUTCOMES AND MEASURES: Risk of osteoporotic hip fracture and vertebral fracture was compared between dabigatran and warfarin users using Poisson regression. The corresponding incidence rate ratio (IRR) and absolute risk difference (ARD) with 95% CIs were calculated. RESULTS: Among 51 496 patients newly diagnosed with NVAF, 8152 new users of dabigatran (n = 3268) and warfarin (n = 4884) were matched by propensity score (50% women; mean [SD] age, 74 [11] years). Osteoporotic fracture developed in 104 (1.3%) patients during follow-up (32 dabigatran users [1.0%]; 72 warfarin users [1.5%]). Results of Poisson regression analysis showed that dabigatran use was associated with a significantly lower risk of osteoporotic fracture compared with warfarin (0.7 vs 1.1 per 100 person-years; ARD per 100 person-years, −0.68 [95% CI, −0.38 to −0.86]; IRR, 0.38 [95% CI, 0.22 to 0.66]). The association with lower risk was statistically significant in patients with a history of falls, fractures, or both (dabigatran vs warfarin, 1.6 vs 3.6 per 100 person-years; ARD per 100 person-years, −3.15 [95% CI, −2.40 to −3.45]; IRR, 0.12 [95% CI, 0.04 to 0.33]), but not in those without a history (0.6 vs 0.7 per 100 person-years; ARD per 100 person-years, −0.04 [95% CI, 0.67 to −0.39]; IRR, 0.95 [95% CI, 0.45 to 1.96]) (P value for interaction, <.001). CONCLUSIONS AND RELEVANCE: Among adults with NVAF receiving anticoagulation, the use of dabigatran compared with warfarin was associated with a lower risk of osteoporotic fracture. Additional study, perhaps including randomized clinical trials, may be warranted to further understand the relationship between use of dabigatran vs warfarin and risk of fracture.

Type: Article
Title: Association between Dabigatran vs Warfarin and Risk of Osteoporotic Fractures among Patients with Nonvalvular Atrial Fibrillation
Open access status: An open access version is available from UCL Discovery
DOI: 10.1001/jama.2017.1363
Publisher version: http://dx.doi.org/10.1001/jama.2017.1363
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
URI: https://discovery.ucl.ac.uk/id/eprint/1542445
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