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Hip fractures risks in edoxaban versus warfarin users: A propensity score-matched population-based cohort study with competing risk analyses.
- Source :
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Bone [Bone] 2022 Mar; Vol. 156, pp. 116303. Date of Electronic Publication: 2021 Dec 29. - Publication Year :
- 2022
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Abstract
- Objective: The three direct oral anticoagulants (DOAC), rivaroxaban, apixaban and dabigatran have been associated with lower risks of fractures compared to warfarin. However, no large scale studies have explored the associations with the newest DOAC, edoxaban, with fracture risk. The present study aims to elucidate the effects of edoxaban on the risk of hip fracture amongst elderly patients by comparing the incidence of new onset hip fracture between edoxaban and warfarin users in a Chinese population.<br />Methods: This was a retrospective population-based cohort study of patients with edoxaban or warfarin use between January 1st, 2016 and December 31st, 2019 in Hong Kong, China. Patients with less than one-month exposure, medication switching between warfarin and edoxaban, those who died within 30 days after drug exposure, prior human immunodeficiency virus infection, age <50 years old, and those with prior hip fractures were excluded. Propensity score matching (1:2) between edoxaban and warfarin users using the nearest neighbour method was performed based on demographics, prior comorbidities, and use of different medications. The study outcomes were new onset hip fractures, medically attended falls and all-cause mortality.<br />Results: A total of 5014 patients including 579 edoxaban users and 4435 warfarin users (median age: 70 years old [interquartile range (IQR): 62-79], 56.66% males) with a median follow-up of 637.5 (IQR: 320-1073) days were included. In the matched cohort, edoxaban users had significantly lower rates of new onset hip fractures, medically attended falls and all-cause mortality. The protective value of edoxaban use against new onset hip fracture (hazard ratio [HR]: 0.13, 95% confidence interval [CI]: [0.03-0.54], p = 0.0051), medically attended falls (HR: 0.47, [0.29-0.75], p = 0.0018) and all-cause mortality (HR: 0.61, [0.42-0.87], p = 0.0059) in comparison to warfarin use persisted after matching. The significant relationship between edoxaban use and lower fracture risk was preserved in all sensitivity analyses using different approaches using the propensity score.<br />Conclusions: Edoxaban use is associated with lower risks of new onset hip fractures, medically attended falls and mortality risks compared to warfarin after propensity score matching.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Administration, Oral
Aged
Anticoagulants adverse effects
Cohort Studies
Female
Humans
Male
Middle Aged
Propensity Score
Pyridines
Retrospective Studies
Risk Assessment
Thiazoles
Warfarin adverse effects
Atrial Fibrillation chemically induced
Atrial Fibrillation drug therapy
Atrial Fibrillation epidemiology
Hip Fractures drug therapy
Stroke
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2763
- Volume :
- 156
- Database :
- MEDLINE
- Journal :
- Bone
- Publication Type :
- Academic Journal
- Accession number :
- 34973496
- Full Text :
- https://doi.org/10.1016/j.bone.2021.116303