Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis
Background: Current evidence regarding the application of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) on the fracture risk is inconsistent. Therefore, we conducted a meta-analysis to evaluate the fracture risk of DOACs vs. VKAs in patients with atrial fibrillation (AF).Method...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2021-07-01
|
Series: | Frontiers in Cardiovascular Medicine |
Subjects: | |
Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.713187/full |
id |
doaj-5bf8fab77fa74499ab16b9f6ee7a30d8 |
---|---|
record_format |
Article |
spelling |
doaj-5bf8fab77fa74499ab16b9f6ee7a30d82021-07-22T05:55:33ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-07-01810.3389/fcvm.2021.713187713187Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-AnalysisXiaojuan Wu0Linyan Hu1Jinjin Liu2Qiuping Gu3Department of Gastroenterology, Ganzhou People's Hospital, Ganzhou, ChinaHengshui Health School, Hengshui, ChinaDepartment of Oncology, Ganzhou People's Hospital, Ganzhou, ChinaDepartment of Gastroenterology, Ganzhou People's Hospital, Ganzhou, ChinaBackground: Current evidence regarding the application of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) on the fracture risk is inconsistent. Therefore, we conducted a meta-analysis to evaluate the fracture risk of DOACs vs. VKAs in patients with atrial fibrillation (AF).Methods: The PubMed and Embase databases were systematically searched until June 2021 for all the studies that reported oral anticoagulants in AF patients. The random-effect model with an inverse variance method was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs).Results: A total of 10 studies were included in this meta-analysis. Among AF patients receiving anticoagulants, DOAC users showed a reduced risk of any fracture compared to those with VKAs (RR = 0.80; 95% CI: 0.70–0.91) regardless of gender [males (RR = 0.79; 95% CI: 0.67–0.92) and females (RR = 0.71; 95% CI: 0.57–0.89)]. Apixaban (RR = 0.75; 95% CI: 0.60–0.92) and rivaroxaban (RR = 0.73; 95% CI: 0.61–0.88), but not dabigatran and edoxaban, were associated with a decreased risk of any fracture compared with VKAs. DOAC users had decreased risks of osteoporotic fractures (RR = 0.63; 95% CI: 0.47–0.84) and hip/pelvic fractures (RR = 0.88; 95% CI: 0.79–0.97) compared to those treated with VKAs.Conclusions: Our meta-analysis suggested that the use of DOACs was associated with a reduced risk of any fracture compared with VKAs. Further studies should confirm our findings.https://www.frontiersin.org/articles/10.3389/fcvm.2021.713187/fullatrial fibrillationnon-vitamin K antagonist oral anticoagulantswarfarinfracturemeta |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xiaojuan Wu Linyan Hu Jinjin Liu Qiuping Gu |
spellingShingle |
Xiaojuan Wu Linyan Hu Jinjin Liu Qiuping Gu Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis Frontiers in Cardiovascular Medicine atrial fibrillation non-vitamin K antagonist oral anticoagulants warfarin fracture meta |
author_facet |
Xiaojuan Wu Linyan Hu Jinjin Liu Qiuping Gu |
author_sort |
Xiaojuan Wu |
title |
Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis |
title_short |
Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis |
title_full |
Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis |
title_fullStr |
Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis |
title_full_unstemmed |
Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis |
title_sort |
association of direct oral anticoagulants vs. vitamin k antagonists with fractures in atrial fibrillation patients: a systematic review and meta-analysis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Cardiovascular Medicine |
issn |
2297-055X |
publishDate |
2021-07-01 |
description |
Background: Current evidence regarding the application of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) on the fracture risk is inconsistent. Therefore, we conducted a meta-analysis to evaluate the fracture risk of DOACs vs. VKAs in patients with atrial fibrillation (AF).Methods: The PubMed and Embase databases were systematically searched until June 2021 for all the studies that reported oral anticoagulants in AF patients. The random-effect model with an inverse variance method was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs).Results: A total of 10 studies were included in this meta-analysis. Among AF patients receiving anticoagulants, DOAC users showed a reduced risk of any fracture compared to those with VKAs (RR = 0.80; 95% CI: 0.70–0.91) regardless of gender [males (RR = 0.79; 95% CI: 0.67–0.92) and females (RR = 0.71; 95% CI: 0.57–0.89)]. Apixaban (RR = 0.75; 95% CI: 0.60–0.92) and rivaroxaban (RR = 0.73; 95% CI: 0.61–0.88), but not dabigatran and edoxaban, were associated with a decreased risk of any fracture compared with VKAs. DOAC users had decreased risks of osteoporotic fractures (RR = 0.63; 95% CI: 0.47–0.84) and hip/pelvic fractures (RR = 0.88; 95% CI: 0.79–0.97) compared to those treated with VKAs.Conclusions: Our meta-analysis suggested that the use of DOACs was associated with a reduced risk of any fracture compared with VKAs. Further studies should confirm our findings. |
topic |
atrial fibrillation non-vitamin K antagonist oral anticoagulants warfarin fracture meta |
url |
https://www.frontiersin.org/articles/10.3389/fcvm.2021.713187/full |
work_keys_str_mv |
AT xiaojuanwu associationofdirectoralanticoagulantsvsvitaminkantagonistswithfracturesinatrialfibrillationpatientsasystematicreviewandmetaanalysis AT linyanhu associationofdirectoralanticoagulantsvsvitaminkantagonistswithfracturesinatrialfibrillationpatientsasystematicreviewandmetaanalysis AT jinjinliu associationofdirectoralanticoagulantsvsvitaminkantagonistswithfracturesinatrialfibrillationpatientsasystematicreviewandmetaanalysis AT qiupinggu associationofdirectoralanticoagulantsvsvitaminkantagonistswithfracturesinatrialfibrillationpatientsasystematicreviewandmetaanalysis |
_version_ |
1721292076010700800 |