Background Warfarin, a vitamin K antagonist, has been shown to affect bone mineral density and cause osteoporosis. However, studies investigating the relationship between non-vitamin K antagonist oral anticoagulants (NOACs) and osteoporosis are limited. We thus compared the risk of osteoporosis in patients with atrial fibrillation treated with either NOACs or warfarin. Methods and Results This nationwide, retrospective cohort study used Taiwan's National Health Insurance Research Database. All adult patients in Taiwan who were newly diagnosed with atrial fibrillation and treated with NOACs or warfarin between January 2012 and December 2015 were included and classified into their respective cohorts. Patients who received NOACs were subcategorized into the rivaroxaban, dabigatran, and apixaban subgroups. Propensity score matching was performed for each head-to-head comparison. Adjusted hazard ratios (aHRs) for the risk of osteoporosis were calculated using Cox proportional hazards regression models, with adjustment for confounders. Overall, 17 008 patients were included, with 8504 in each cohort. NOACs were associated with a lower osteoporosis risk than warfarin (aHR=0.82; 95% CI=0.68-0.97). A subgroup effect of treatment duration was identified (namely, the lower osteoporosis risk with NOAC compared with warfarin became stronger in those with longer treatment duration [P for interaction <0.001]). Furthermore, significantly lower risks of osteoporosis were observed in the rivaroxaban (aHR=0.68; 95% CI=0.55-0.83) and apixaban (aHR=0.38; 95% CI=0.22-0.66) subgroups, but not in the dabigatran subgroup (aHR=1.04; 95% CI=0.85-1.27). Conclusions Compared with warfarin, rivaroxaban and apixaban were associated with a significantly lower risk of osteoporosis in patients with atrial fibrillation.

译文

背景: 华法林是一种维生素k拮抗剂,已被证明会影响骨矿物质密度并引起骨质疏松症。然而,研究非维生素k拮抗剂口服抗凝剂 (NOACs) 与骨质疏松症之间关系的研究有限。因此,我们比较了使用NOACs或华法林治疗的房颤患者的骨质疏松症风险。方法和结果这项全国性的回顾性队列研究使用了台湾的国民健康保险研究数据库。纳入了台湾所有新诊断为房颤并在2012年1月和2015年12月之间接受NOACs或华法林治疗的成年患者,并将其分类为各自的队列。接受NOACs的患者分为利伐沙班,达比加群和阿哌沙班亚组。对每次头对头比较进行倾向评分匹配。使用Cox比例风险回归模型计算骨质疏松症风险的校正风险比 (aHRs),并对混杂因素进行校正。总体而言,包括17 008名患者,每个队列中有8504名。与华法林相比,NOACs与更低的骨质疏松症风险相关 (aHR = 0.82; 95% CI = 0.68-0.97)。确定了治疗持续时间的亚组效应 (即,在治疗持续时间较长的患者中,与华法林相比,NOAC降低的骨质疏松症风险变得更强 [相互作用P <0.001])。此外,在利伐沙班 (aHR = 0.68; 95% CI = 0.55-0.83) 和阿哌沙班 (aHR = 0.38; 95% CI = 0.22-0.66) 亚组中观察到明显更低的骨质疏松症风险,但在达比加群亚组中没有观察到 (aHR = 1.04; 95% CI = 0.85-1.27)。结论与华法林相比,利伐沙班和阿哌沙班与房颤患者发生骨质疏松的风险显著降低相关。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录