Osteoporotic fractures can be a dangerous complication for patients with atrial fibrillation (AF) taking anticoagulants. Researchers from China and the United Kingdom have recently conducted a population based cohort study to compare the risk for osteoporotic fracture associated with different anticoagulants. The study included 23,515 patients diagnosed with AF between 2010-2017 (mean age 74.4 years) with new prescriptions for warfarin (n = 9541) or direct oral anticoagulants (DOACs) including apixaban, dabigatran and rivaroxaban (n = 3241, 6867 and 3866, respectively). 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]) in the median follow-up period of 423 days. After 24 months’ follow-up, risk of osteoporotic fracture was lower among DOAC users in comparison to warfarin users and no differences in all head-to-head comparisons between DOACs were identifiable. These findings suggest that for patients with AF, the risk for osteoporotic fracture may be less when a DOAC is used, in comparison to the risk with warfarin: this may be an important factor when choosing an anticoagulant in clinical practice. The full details of this study can be viewed here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh