Use of vitamin K antagonist (VKA) anticoagulant does not increase the odds of fracture for either overall or specific types of fractures among VKA users compared with control group or non-vitamin K antagonist oral anticoagulant (NOAC) users, according to a meta-analysis published in the Journal of General Internal Medicine.
Researchers conducted a meta-analysis of 22 observational studies (prospective cohort, n= 8 ; case-control, n= 3; retrospective cohort, n= 7; cross-sectional, n= 4) and 1 randomised controlled trial involving 1,121,582 participants identified through a literature search on the PubMed, EMBASE, and Cochrane databases. They assessed the risk for fractures in adults who received VKA vs control groups and NOAC users.
Pooled results of all studies demonstrated that VKA use did not increase the odds of fracture vs control groups (pooled odds ratio [OR], 1.01; 95% CI, 0.89-1.14) and NOAC users (OR, 0.95; 95% CI, 0.78-1.15). In the sub-group analysis, no difference was found for hip (OR, 0.91; 95% CI, 0.69-1.20), vertebral (OR, 1.18; 95% CI, 0.96-1.46), wrist (OR, 1.06; 95% CI, 0.87-1.30), rib (OR, 1.14; 95% CI, 0.86-1.50), men VKA users (OR, 1.26; 95% CI, 0.93-1.72), and those using VKAs for ≥1 year (OR, 1.07; 95% CI, 0.90- 1.27) vs control groups. Significantly increased odds of fracture were observed in female VKA users (pooled OR, 1.11; 95% CI, 1.02-1.21) and VKA users aged ≥65 years (pooled OR, 1.07; 95% CI, 1.01- 1.14) vs control groups.
The authors said: “Our findings highlight that when anticoagulation is necessary, fracture risk should not be the main consideration. In females and patients aged 65 and older, the magnitude for fracture risk was small and clinically insignificant and hence physicians can make an informed choice of anticoagulant.”