A Network Meta-Analysis Comparing Osteoporotic Fracture among Different Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Atrial Fibrillation

• DOI: 10.11005/jbm.2021.28.2.139
• Publication Date: 2021-06-09T00:36:04Z
• Authors: Dibbendhu Khanra; Anindya Mukherjee; Saurabh Deshpande; Hassan Khan; Sanjeev Kathuria; Danesh Kella; Deepak Padmanabhan
• Keywords: Apixaban; Edoxaban

Background There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic among 5 treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, VKA. Methods Ten studies, including randomized control trials population-based with total 321,844 patients (148,751 173,093 VKA DOAC group, respectively) median follow-up 2 years, were included. A Bayesian random-effects NMA model arms was performed using MetInsight V3. Sensitivity analysis excluded highest residual deviances from model. Results The mean age 70 years. favored DOACs over significantly lower fracture (odds ratio [OR], 0.77; 95% credible interval [CrI], 0.70-0.86). demonstrated that apixaban dabigatran (OR, 0.64; CrI, 0.44-0.95); however, statistically similar rivaroxaban 0.84; 0.58-1.24) 1.32; 0.90-1.87). Based on NMA, probability lowest followed by dabigatran. Conclusions decision to prescribe elderly AF should be made not only based thrombotic bleeding risks but also fracture; these factors considered incorporated contemporary cardiology practice. Key words: Atrial · Factor Xa inhibitors Network Osteoporotic Vitamin