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Chen S, Fu K, Cai Q, Feng Y, He H, Gao Y, Zhu Z, Jin D, Sheng J, Zhang C. Development of a risk-predicting score for hip preservation with bone grafting therapy for osteonecrosis. iScience 2024; 27:109332. [PMID: 38500832 PMCID: PMC10946322 DOI: 10.1016/j.isci.2024.109332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/02/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Identification and differentiation of appropriate indications on hip preserving with bone grafting therapy remains a crucial challenge in the treatment of osteonecrosis of the femoral head (ONFH). A prospective cohort study on bone grafting therapy for ONFH aimed to evaluate hip survival rates, and to establish a risk scoring derived from potential risk factors (multivariable model) for hip preservation. Eight variables were identified to be strongly correlated with a decreased rate of hip survival post-therapy, and a comprehensive risk scoring was developed for predicting hip-preservation outcomes. The C-index stood at 0.72, and the areas under the receiver operating characteristics for the risk score's 5- and 10-year hip failure event predictions were 0.74 and 0.72, respectively. This risk score outperforms conventional methods in forecasting hip preservation. Bone grafting shows sustained benefits in treating ONFH when applied under the right indications. Furthermore, the risk scoring proves valuable as a decision-making tool, facilitating risk stratification for ONFH treatments in future.
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Affiliation(s)
- Shengbao Chen
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Kai Fu
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Qianying Cai
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Yong Feng
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Haiyan He
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Yun Gao
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Zhenzhong Zhu
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Dongxu Jin
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Jiagen Sheng
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Changqing Zhang
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
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Bostan SA, Özarslantürk S, Günaçar DN, Gonca M, Göller Bulut D, Ok Bostan H. Direct-Acting Oral Anticoagulant/Vitamin K Antagonists: Do They Affect the Trabecular and Cortical Structure of the Mandible? J Clin Densitom 2024; 27:101495. [PMID: 38688206 DOI: 10.1016/j.jocd.2024.101495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND This study aimed to evaluate the mandibular bone structure of patients using oral anticoagulants (OACs) vitamin K antagonist drugs (warfarin) and other OACs including direct oral anticoagulants [(DOACs) apixaban, rivaroxaban, dabigatran, edoxaban]. Analyses were based upon the fractal dimension (FD), the panoramic mandibular index (PMI) and the Klemetti index (KI), which is also known as the mandibular cortical index (MCI). METHODOLOGY Ninety participants were divided into three groups: group 1: 30 systemically healthy individuals who had not used any anticoagulants before, group 2: 30 individuals using warfarin, and group 3: 30 individuals using DOACs. FD was used to analyze trabecular bone architecture in the condyle, angle, and two sites in the alveolar bone. PMI was used to evaluate the quantity of cortical bone and KI was used to evaluate the cortical bone quality. RESULTS There was no difference between the groups regarding FD analysis and KI; however, a difference was found between groups 1, 2, and 3 in the PMI (P≤ 0.001). The PMI in group 1 was higher than in groups 2 and 3. CONCLUSION Mandibular radiomorphometric indices can be used on panoramic radiographs to evaluate the quantity of mandibular cortical bone in patients using oral anticoagulants.
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Affiliation(s)
- Semih Alperen Bostan
- Recep Tayyip Erdoğan University, Faculty of Dentistry, Department of Periodontology, Rize, Turkey
| | - Savaş Özarslantürk
- University of Health Sciences, Gulhane Faculty of Dental Medicine, Department of Dentomaxillofacial Radiology, Ankara, Turkey
| | - Dilara Nil Günaçar
- Recep Tayyip Erdoğan University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Rize, Turkey
| | - Merve Gonca
- Recep Tayyip Erdoğan University, Faculty of Dentistry, Department of Orthodontics, Rize, Turkey
| | - Duygu Göller Bulut
- Bolu Abant İzzet Baysal University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Bolu, Turkey
| | - Hilal Ok Bostan
- Recep Tayyip Erdoğan University, Faculty of Dentistry, Department of Prosthodontics, Rize, Turkey.
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Korotkov Z, Nissan R, Hershkovitz A. Anticoagulation drug use and rehabilitation outcomes in post-acute hip fractured patients. Disabil Rehabil 2023; 45:4272-4278. [PMID: 36420872 DOI: 10.1080/09638288.2022.2148301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the relationship between anticoagulant use and rehabilitation outcomes in post-acute hip fracture patients. METHODS A retrospective study (1/2017 to 5/2019) of 299 hip fractured patients. OUTCOME MEASURES Functional Independence Measure (FIM) and the motor FIM's effectiveness. RESULTS Patients treated with anticoagulation drugs exhibited a significant longer latency time from fracture to surgery (U = -4.37, p < 0.001) and from surgery to rehabilitation (U=-2.27, p = 0.023), and a significantly higher rate of cardiovascular diseases (χ2=0.15, p= 0.023) compared with untreated patients. No significant differences between the two patient groups were found regarding the rate of blood transfusions, perioperative complications (infections, reoperation), or functional outcome measures. CONCLUSIONS Oral anticoagulants are not associated with rehabilitation outcomes of hip fracture patients.Implications rehabilitationAnticoagulation drug use is not associated with functional outcome of post-acute hip fracture patients.It is recommended to renew oral anticoagulants for patients on chronic treatment after surgery since no negative outcomes were found during rehabilitation under anticoagulant treatment and in light of the importance of these drugs in preventing thromboembolic complications.
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Affiliation(s)
- Zoya Korotkov
- Geriatric Rehabilitation Ward "D", Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Ran Nissan
- Geriatric Rehabilitation Ward "D", Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Avital Hershkovitz
- Geriatric Rehabilitation Ward "D", Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Yang N, Zhao Y, Bai Z, Chen H, Ning H, Zou M, Cheng G. The association of non-vitamin K antagonist oral anticoagulants vs. warfarin and the risk of fractures for patients with atrial fibrillation: a systematic review and meta-analysis. Acta Cardiol 2022; 78:298-310. [PMID: 36063197 DOI: 10.1080/00015385.2022.2030555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The fracture risks of non-vitamin K antagonist oral anticoagulants (NOACs) vs. warfarin in patients with atrial fibrillation (AF) remain controversial. METHODS PubMed, Cochrane Library, EMBASE, Clinical Trials.gov databases for RCTs, and cohort studies were systematically searched from inception to 10 June 2021. RESULTS Twelve-two studies met the inclusion criteria and 477,821 patients were included. Warfarin increased the risk of fracture in AF patients compared with NOACs in overall any fracture (RR = 0.79; 95% CI = 0.70-10.88; p = 0.00), osteoporotic fracture (RR = 0.746; 95% CI = 0.630-0.883; p = 0.001). No significant difference was observed in the hip or pelvic fracture, vertebral fracture, extremity fracture, wrist fracture, femoral neck fracture, and ankle fracture. In subgroup analyses based on several aspects, NOACs were associated with a significant reduction in any fracture (standard dosage NOACs, cohort studies, elderly patients, rivaroxaban in RCTs, dabigatran, rivaroxaban, and apixaban in cohort studies), in the hip/pelvic fracture (follow-up time ≤1 year, cohort studies), and osteoporotic fracture (cohort studies). CONCLUSION NOACs were associated with a significantly lower risk of any fracture and osteoporotic fracture compared to warfarin. This benefit was also observed in specific NOACs types of dabigatran, rivaroxaban, and apixaban. However, whether NOACs had a less fracture risk than warfarin on the other risk of fractures was still uncertain.
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Affiliation(s)
- Nana Yang
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Ying Zhao
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Zhaohui Bai
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Haokun Chen
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Haoyu Ning
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Meijuan Zou
- Pharmaceutical College, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Gang Cheng
- Pharmaceutical College, Shenyang Pharmaceutical University, Shenyang, Liaoning, China.,NMPA Key Laboratory for Research and Evaluation of Drug Regulatory Technology, Shenyang, Liaoning, China
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Tsai SHL, Hu CW, Shao SC, Tischler EH, Obisesan OH, Vervoort D, Chen WC, Hu JR, Kuo LT. Comparative Risks of Fracture Among Direct Oral Anticoagulants and Warfarin: A Systematic Review and Network Meta-Analysis. Front Cardiovasc Med 2022; 9:896952. [PMID: 35677694 PMCID: PMC9168033 DOI: 10.3389/fcvm.2022.896952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 12/02/2022] Open
Abstract
Importance Previous studies have shown the effectiveness and safety of direct oral anticoagulants (DOACs), including lower fracture risks, compared to warfarin. However, direct or indirect comparisons between different DOACs are scarce in the literature. Objective This study aims to compare fracture risks among different DOACs and warfarin, including apixaban, rivaroxaban, dabigatran, and edoxaban, in patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). Methods We searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science for randomized controlled trials and cohort studies comparing the fracture risks among patients who used warfarin or DOACs, up to March 2021. Two authors extracted data and appraised the risk of bias of included studies. The primary outcome was fracture risk. We performed pairwise meta-analyses to compare differences between medications and network meta-analyses using frequentist random-effects models to compare through indirect evidence. We used surface under the cumulative ranking curve (SUCRA) and mean ranks to determine the probability of a DOAC ranking best in terms of fracture risk. Results Thirty-one studies were included in the final analysis. Twenty-four randomized controlled trials and seven cohort studies with 455,343 patients were included in the systematic review and network meta-analysis. Compared to warfarin, the risk of any fractures was lowest with apixaban [relative risk (RR) = 0.59; 95% confidence interval (CI): 0.48-0.73], followed by rivaroxaban (RR: 0.72; 95% CI: 0.60-0.86), edoxaban (RR: 0.88; 95% CI: 0.62-1.23), and dabigatran (RR = 0.90; 95% CI: 0.75-1.07). No substantial inconsistency between direct and indirect evidence was detected for all outcomes. Conclusions All DOACs were safer than warfarin concerning the risk of fracture; however, apixaban had the lowest relative risk of fracture within the class of DOACs. Further head-to-head prospective studies should confirm the comparative safety profiles of DOACs regarding fractures.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Wei Hu
- Department of Orthopaedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Eric H. Tischler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, New York, NY, United States
| | - Olufunmilayo H. Obisesan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Dominique Vervoort
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Wei Cheng Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jiun-Ruey Hu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Liang-Tseng Kuo
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Zhou J, Lee S, Liu X, Iltaf Satti D, Tai Loy Lee T, Hou In Chou O, Chang C, Roever L, Tak Wong W, Ka Chung Wai A, Liu T, Zhang Q, Tse G. Hip fractures risks in edoxaban versus warfarin users: A propensity score-matched population-based cohort study with competing risk analyses. Bone 2022; 156:116303. [PMID: 34973496 DOI: 10.1016/j.bone.2021.116303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/02/2022]
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. 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. 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. 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.
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Affiliation(s)
- Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Sharen Lee
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Xuejin Liu
- School of Educational Science, Kaili University, Kaili City, Guizhou, China
| | - Danish Iltaf Satti
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Teddy Tai Loy Lee
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration; Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Oscar Hou In Chou
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration; Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Carlin Chang
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qingpeng Zhang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Gary Tse
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Kent and Medway Medical School, Canterbury, UK.
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7
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Fusaro M, Tondolo F, Gasperoni L, Tripepi G, Plebani M, Zaninotto M, Nickolas TL, Ketteler M, Aghi A, Politi C, La Manna G, Brandi ML, Ferrari S, Gallieni M, Mereu MC, Cianciolo G. The Role of Vitamin K in CKD-MBD. Curr Osteoporos Rep 2022; 20:65-77. [PMID: 35132525 PMCID: PMC8821802 DOI: 10.1007/s11914-022-00716-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW We describe the mechanism of action of vitamin K, and its implication in cardiovascular disease, bone fractures, and inflammation to underline its protective role, especially in chronic kidney disease (CKD). RECENT FINDINGS Vitamin K acts as a coenzyme of y-glutamyl carboxylase, transforming undercarboxylated in carboxylated vitamin K-dependent proteins. Furthermore, through the binding of the nuclear steroid and xenobiotic receptor, it activates the expression of genes that encode proteins involved in the maintenance of bone quality and bone remodeling. There are three main types of K vitamers: phylloquinone, menaquinones, and menadione. CKD patients, for several conditions typical of the disease, are characterized by lower levels of vitamin K than the general populations, with a resulting higher prevalence of bone fractures, vascular calcifications, and mortality. Therefore, the definition of vitamin K dosage is an important issue, potentially leading to reduced bone fractures and improved vascular calcifications in the general population and CKD patients.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Via G. Moruzzi 1, 56124, Pisa, Italy.
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Francesco Tondolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lorenzo Gasperoni
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Thomas L Nickolas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York City, NY, USA
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Cristina Politi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, HUG, Genève, Switzerland
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', Università di Milano, 20157, Milano, Italy
| | | | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Xie X, Liu Y, Li J, Gu F, Zhang K, Sui Z, Zhang J, Yu T. Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review. Age Ageing 2022; 51:6514231. [PMID: 35077554 PMCID: PMC8789302 DOI: 10.1093/ageing/afab264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/13/2021] [Indexed: 01/10/2023] Open
Abstract
Aims evidence on the difference in fracture risks for patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) versus warfarin remains controversial. We aim to compare the fracture risks between the DOAC and warfarin prescriptions among the AF patients. Methods and Results we systematically searched PubMed, EMBASE, the Cochrane Library and Web of Science up to 19 April 2021 for relevant studies. And the observational studies regarding the relationship between the DAOC versus warfarin prescriptions and fracture risks among the patients with AF were included in this meta-analysis. Two investigators independently screened the articles and extracted the relevant data. A random- or fixed-effect model was applied to calculate the pooled hazard ratio/relative ratios with 95% confidence intervals of fracture risks associated with the DOAC and warfarin prescriptions. Six studies comprising 351,208 patients and 9,424 fractures were included in this meta-analysis. Overall, the AF patients treated with DOACs tend to present a lower risk of any fracture compared with those treated with warfarin (relative ratio: 0.82, 95% confidence interval (CI): 0.74–0.91). Sub-analyses for each individual DOAC indicate that apixaban and rivaroxan are associated with lower risk of any fracture compared with warfarin (HR: 0.75, 95% CI: 0.60–0.92, and HR: 0.79, 95% CI: 0.71–0.88, respectively). Conclusion this meta-analysis suggests that DOAC users have a lower risk of fractures than the warfarin users. The results of this study may provide optimal anticoagulation opportunities for AF patients with high fracture risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Tiecheng Yu
- Address correspondence to: Tiecheng Yu, Department of Orthopedics, The First Hospital of Jilin University, Changchun, China. Tel: +(0086) 135-9605-8780; E-mail:
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Crea F. Hot topics in congenital heart disease and new insight into ventricular non-compaction. Eur Heart J 2021; 42:4197-4201. [PMID: 34724708 DOI: 10.1093/eurheartj/ehab746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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10
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Crea F. Thrombosis in peripheral artery disease and thrombotic thrombocytopenia after adenoviral COVID-19 vaccination. Eur Heart J 2021; 42:3995-3999. [PMID: 34649281 PMCID: PMC8524636 DOI: 10.1093/eurheartj/ehab712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Cases A, Gomez P, Broseta JJ, Perez Bernat E, Arjona Barrionuevo JDD, Portolés JM, Gorriz JL. Non-valvular Atrial Fibrillation in CKD: Role of Vitamin K Antagonists and Direct Oral Anticoagulants. A Narrative Review. Front Med (Lausanne) 2021; 8:654620. [PMID: 34604247 PMCID: PMC8484537 DOI: 10.3389/fmed.2021.654620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in chronic kidney disease (CKD), with a close bidirectional relationship between the two entities. The presence of CKD in AF increases the risk of thromboembolic events, mortality and bleeding. Vitamin K antagonists (VKA) have been the mainstay of treatment for the prevention of thromboembolic events in AF until recently, with confirmed benefits in AF patients with stage 3 CKD. However, the risk-benefit profile of VKA in patients with AF and stages 4-5 CKD is controversial due to the lack of evidence from randomized controlled trials. Treatment with VKA in CKD patients has been associated with conditions such as poorer anticoagulation quality, increased risk of bleeding, faster progression of vascular/valvular calcification and higher risk of calciphylaxis. Direct oral anticoagulants (DOACs) have shown equal or greater efficacy in stroke/systemic embolism prevention, and a better safety profile than VKA in post-hoc analysis of the pivotal randomized controlled trials in patients with non-valvular AF and stage 3 CKD, yet evidence of its risk-benefit profile in more advanced stages of CKD is scarce. Observational studies associate DOACs with a good safety/effectiveness profile compared to VKA in non-dialysis CKD patients. Further, DOACs have been associated with a lower risk of acute kidney injury and CKD development/progression than VKA. This narrative review summarizes the evidence of the efficacy and safety of warfarin and DOACs in patients with AF at different CKD stages, as well as their effects on renal function, vascular/valvular calcification and bone health.
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Affiliation(s)
- Aleix Cases
- Departament de Medicina, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Gomez
- Unidad de Factores de Riesgo Vascular, Servicio de Nefrología, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | | | | | | | | | - Jose Luis Gorriz
- Departament de Medicina, Universitat de Valencia, Valencia, Spain
- Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación del Hospital Clinico Universitario, Valencia (INCLIVA), Valencia, Spain
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12
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Crea F. The ESC Guidelines on cardiac pacing and resynchronization, and the many facets of atrial fibrillation. Eur Heart J 2021; 42:3411-3414. [PMID: 34521100 DOI: 10.1093/eurheartj/ehab628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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13
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Chiang PH, Hsu YC, Wei JCC. Methodological considerations when discussing the fracture risk of atrial fibrillation patients taking different drug. Eur Heart J 2021; 42:3575. [PMID: 34379751 DOI: 10.1093/eurheartj/ehab459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ping-Hao Chiang
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Chih Hsu
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
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14
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Huang HK, Tu YK, Loh CH. Fracture risk associated with different oral anticoagulants in patients with atrial fibrillation: updated evidence from real-world observational studies and clinical trials. Eur Heart J 2021; 42:3576-3577. [PMID: 34379734 DOI: 10.1093/eurheartj/ehab461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Huei-Kai Huang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970, Taiwan.,Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100, Taiwan.,Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan
| | - Ching-Hui Loh
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970, Taiwan.,School of Medicine, Tzu Chi University, No. 701, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970, Taiwan
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15
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Mongkhon P, Fanning L, Wong KHTW, Man KKC, Wong ICK, Lau WCY. Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis. Europace 2021; 23:39-48. [PMID: 33085751 DOI: 10.1093/europace/euaa242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. METHODS AND RESULTS PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian-Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75-0.92, P < 0.001, I2 = 73.0%]. When comparing individual NOAC to VKAs, a statistically significant lower risk of any fractures was found for rivaroxaban (pooled RR = 0.79, 95% CI: 0.71-0.88, P < 0.001, I2 = 55.2%) and apixaban (pooled RR = 0.75, 95% CI: 0.60-0.92, P = 0.007, I2 = 54.5%), but not dabigatran (pooled RR = 0.87, 95% CI: 0.74-1.01, P = 0.061, I2 = 74.6%). No differences were observed in all head-to-head comparisons between NOACs. CONCLUSION This large meta-analysis suggests that NOACs use was associated with a lower risk of fractures compared with VKAs. Fracture risks were similar between NOACs. These findings may help inform the optimal anticoagulant choice for patients with AF at high risk of fracture.
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Affiliation(s)
- Pajaree Mongkhon
- Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
| | - Laura Fanning
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.,Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK
| | - Kirstie H T W Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
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16
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Wu X, Hu L, Liu J, Gu Q. Association of Direct Oral Anticoagulants vs. Vitamin K Antagonists With Fractures in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:713187. [PMID: 34368263 PMCID: PMC8339256 DOI: 10.3389/fcvm.2021.713187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Current evidence regarding the application of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) on the fracture risk is inconsistent. Therefore, we conducted a meta-analysis to evaluate the fracture risk of DOACs vs. VKAs in patients with atrial fibrillation (AF). Methods: The PubMed and Embase databases were systematically searched until June 2021 for all the studies that reported oral anticoagulants in AF patients. The random-effect model with an inverse variance method was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs). Results: A total of 10 studies were included in this meta-analysis. Among AF patients receiving anticoagulants, DOAC users showed a reduced risk of any fracture compared to those with VKAs (RR = 0.80; 95% CI: 0.70–0.91) regardless of gender [males (RR = 0.79; 95% CI: 0.67–0.92) and females (RR = 0.71; 95% CI: 0.57–0.89)]. Apixaban (RR = 0.75; 95% CI: 0.60–0.92) and rivaroxaban (RR = 0.73; 95% CI: 0.61–0.88), but not dabigatran and edoxaban, were associated with a decreased risk of any fracture compared with VKAs. DOAC users had decreased risks of osteoporotic fractures (RR = 0.63; 95% CI: 0.47–0.84) and hip/pelvic fractures (RR = 0.88; 95% CI: 0.79–0.97) compared to those treated with VKAs. Conclusions: Our meta-analysis suggested that the use of DOACs was associated with a reduced risk of any fracture compared with VKAs. Further studies should confirm our findings.
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Affiliation(s)
- Xiaojuan Wu
- Department of Gastroenterology, Ganzhou People's Hospital, Ganzhou, China
| | - Linyan Hu
- Hengshui Health School, Hengshui, China
| | - Jinjin Liu
- Department of Oncology, Ganzhou People's Hospital, Ganzhou, China
| | - Qiuping Gu
- Department of Gastroenterology, Ganzhou People's Hospital, Ganzhou, China
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17
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Khanra D, Mukherjee A, Deshpande S, Khan H, Kathuria S, Kella D, Padmanabhan D. A Network Meta-Analysis Comparing Osteoporotic Fracture among Different Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Atrial Fibrillation. J Bone Metab 2021; 28:139-150. [PMID: 34130366 PMCID: PMC8206613 DOI: 10.11005/jbm.2021.28.2.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2001] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic fractures among 5 different treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, and VKA. Methods Ten studies, including 5 randomized control trials and 5 population-based studies, with a total of 321,844 patients (148,751 and 173,093 in the VKA and DOAC group, respectively) with a median follow-up of 2 years, were included. A Bayesian random-effects NMA model comparing fractures among the treatment arms was performed using MetInsight V3. Sensitivity analysis excluded studies with the highest residual deviances from the NMA model. Results The mean age of the patients was 70 years. The meta-analysis favored DOACs over VKA with significantly lower osteoporotic fracture (odds ratio [OR], 0.77; 95% credible interval [CrI], 0.70–0.86). The NMA demonstrated that fractures were significantly lower with apixaban compared with dabigatran (OR, 0.64; 95% CrI, 0.44–0.95); however, fractures were statistically similar between apixaban and rivaroxaban (OR, 0.84; 95% CrI, 0.58–1.24) and dabigatran and rivaroxaban (OR, 1.32; 95% CrI, 0.90–1.87). Based on the Bayesian model of NMA, the probability of osteoporotic fracture was highest with VKA and lowest with apixaban, followed by rivaroxaban, edoxaban, and dabigatran. Conclusions The decision to prescribe anticoagulants in elderly patients with AF should be made not only based on thrombotic and bleeding risks but also on the risk of osteoporotic fracture; these factors should be considered and incorporated in contemporary cardiology practice.
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Affiliation(s)
- Dibbendhu Khanra
- Heart and Lung Center, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | | | - Saurabh Deshpande
- Department of Cardiology, Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India
| | - Hassan Khan
- Center for the Prevention of Cardiovascular Disease, The Leon H. Charney Division of Cardiology, NYU Langone Health, NYU Robert I. Grossman School of Medicine, New York, USA
| | | | | | - Deepak Padmanabhan
- Department of Cardiology, Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India
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18
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Lüscher TF. Challenges in atrial fibrillation: detection, alert systems, fibrosis, and infection. Eur Heart J 2021; 41:1063-1066. [PMID: 33216858 DOI: 10.1093/eurheartj/ehaa153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals, London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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19
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Fusaro M, Cianciolo G, Evenepoel P, Schurgers L, Plebani M. Vitamin K in CKD Bone Disorders. Calcif Tissue Int 2021; 108:476-485. [PMID: 33409597 DOI: 10.1007/s00223-020-00792-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/05/2020] [Indexed: 01/07/2023]
Abstract
Vitamin K is principally known because it is involved in blood coagulation. Furthermore, epidemiological studies showed that its deficit was associated with increased fragility fractures, vascular calcification and mortality. There are two main types of vitamin K vitamers: Phylloquinone (or PK) and Menaquinones (MKn). Vitamin K acts both as coenzyme of y-glutamyl carboxylase (GGCX) transforming undercarboxylated in carboxylated vitamin K-dependent proteins (e.g., Osteocalcin and Matrix Gla Protein) and as a ligand of the nuclear steroid and xenobiotic receptor (SXR) (in murine species Pregnane X Receptor: PXR), expressed in osteoblasts. It has been highlighted that the uremic state is a condition of greater vitamin K deficiency than the general population with resulting higher prevalence of bone fractures, vascular calcifications and mortality. The purpose of this literature review is to evaluate the protective role of Vitamin K in bone health in CKD patients.
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Affiliation(s)
- M Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa Via G. Moruzzi 1, 56124, Pisa, PI, Italy.
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, PD, Italy.
| | - G Cianciolo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - P Evenepoel
- Laboratory of Nephrology, Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - L Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, 6200MD, Maastricht, The Netherlands
| | - M Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
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20
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Huang HK, Yeh JI, Loh CH. Hip fracture risk in patients with atrial fibrillation receiving oral anticoagulants: a meta-analysis based on current observational studies. Eur Heart J 2021; 41:2919-2920. [PMID: 32380541 DOI: 10.1093/eurheartj/ehaa361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Huei-Kai Huang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jih-I Yeh
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ching-Hui Loh
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien 97002, Taiwan
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21
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Huang HK, Peng CCH, Lin SM, Munir KM, Chang RHE, Wu BBC, Liu PPS, Hsu JY, Loh CH, Tu YK. Fracture Risks in Patients Treated With Different Oral Anticoagulants: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e019618. [PMID: 33759542 PMCID: PMC8174313 DOI: 10.1161/jaha.120.019618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Evidence on the differences in fracture risk associated with non-vitamin K antagonist oral anticoagulants (NOAC) and warfarin is inconsistent and inconclusive. We conducted a systematic review and meta-analysis to assess the fracture risk associated with NOACs and warfarin. Methods and Results We searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov from inception until May 19, 2020. We included studies presenting measurements (regardless of primary/secondary/tertiary/safety outcomes) for any fracture in both NOAC and warfarin users. Two or more reviewers independently screened relevant articles, extracted data, and performed quality assessments. Data were retrieved to synthesize the pooled relative risk (RR) of fractures associated with NOACs versus warfarin. Random-effects models were used for data synthesis. We included 29 studies (5 cohort studies and 24 randomized controlled trials) with 388 209 patients. Patients treated with NOACs had lower risks of fracture than those treated with warfarin (pooled RR, 0.84; 95% CI, 0.77-0.91; P<0.001) with low heterogeneity (I2=38.9%). NOACs were also associated with significantly lower risks of hip fracture than warfarin (pooled RR, 0.89; 95% CI, 0.81-0.98; P=0.023). A nonsignificant trend of lower vertebral fracture risk in NOAC users was also observed (pooled RR, 0.74; 95% CI, 0.54-1.01; P=0.061). Subgroup analyses for individual NOACs demonstrated that dabigatran, rivaroxaban, and apixaban were significantly associated with lower fracture risks. Furthermore, the data synthesis results from randomized controlled trials and real-world cohort studies were quite consistent, indicating the robustness of our findings. Conclusions Compared with warfarin, NOACs are associated with lower risks of bone fracture.
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Affiliation(s)
- Huei-Kai Huang
- Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan.,Departments of Family Medicine and Medical Research Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical Foundation Hualien Taiwan
| | - Carol Chiung-Hui Peng
- Department of Internal Medicine University of Maryland Medical Center Midtown Campus Baltimore MD
| | - Shu-Man Lin
- Department of Physical Medicine and Rehabilitation Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical Foundation Hualien Taiwan.,School of Medicine Tzu Chi University Hualien Taiwan
| | - Kashif M Munir
- Division of Endocrinology, Diabetes and Nutrition University of Maryland School of Medicine Baltimore MD
| | | | - Brian Bo-Chang Wu
- School of Medicine College of Medicine Fu-Jen Catholic University New Taipei City Taiwan
| | - Peter Pin-Sung Liu
- Center for Aging and Health Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical Foundation Hualien Taiwan
| | - Jin-Yi Hsu
- School of Medicine Tzu Chi University Hualien Taiwan.,Center for Aging and Health Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical Foundation Hualien Taiwan
| | - Ching-Hui Loh
- School of Medicine Tzu Chi University Hualien Taiwan.,Center for Aging and Health Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical Foundation Hualien Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan.,Department of Dentistry National Taiwan University Hospital and School of DentistryNational Taiwan University Taipei Taiwan.,Research Center of Big Data and Meta-analysis Wan Fang HospitalTaipei Medical University Taipei Taiwan
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22
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Kim D, Yang PS, Sung JH, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Lip GYH, Joung B. Risk for osteoporotic fractures in patients with atrial fibrillation using different oral anticoagulants. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to investigate the comparative risk of fracture among patients with atrial fibrillation (AF) treated with warfarin or non-vitamin K antagonist oral anticoagulants (NOACs).
Methods
Using the Korean National Health Insurance Service database, patients with AF who received a prescription for apixaban, dabigatran, rivaroxaban, or warfarin between 2013 and 2016 were included. Risk of major fractures (osteoporotic hip, vertebral, or pelvic fractures) were compared using inverse probability of treatment weighting.
Results
There were 70,481 patients identified (41.3% women; mean [SD] age 70.5 [11.3] years); 16,992 apixaban, 22,514 dabigatran, 27,998 rivaroxaban, and 29,390 warfarin users. During a median follow-up of 390 days, 2412 major fractures occurred with weighted incidences per 100 patient-years of 2.56 for apixaban, 2.39 for dabigatran, 2.78 for rivaroxaban, and 3.43 for warfarin. NOAC use was associated with a lower risk for fracture than warfarin use: HR 0.70 (95% confidence interval [CI] 0.57–0.86) for apixaban, HR 0.69 (95% CI 0.60–0.78) for dabigatran, and HR 0.79 (95% CI 0.70–0.90) for rivaroxaban. In head-to-head comparisons between NOACs, there was no significant difference between apixaban and dabigatran. Rivaroxaban was associated with a higher risk for fracture than dabigatran (HR 1.15, 95% CI 1.02–1.31).
Conclusion
In patients with AF, NOAC use may result in a lower risk for osteoporotic fracture compared with warfarin use. Fracture risk does not seem to be altered by the choice of NOAC type, except for rivaroxaban. These associations may help inform benefit–risk assessments when choosing between the different anticoagulant types.
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23
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Chen J, Lyu L, Shen J, Zeng C, Chen C, Wei T. The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis. PeerJ 2021; 9:e10683. [PMID: 33552723 PMCID: PMC7842143 DOI: 10.7717/peerj.10683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.
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Affiliation(s)
- Jun Chen
- Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingchun Lyu
- Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Jiayi Shen
- Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Chunlai Zeng
- Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Cheng Chen
- Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Tiemin Wei
- Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang, China
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Huang HK, Liu PPS, Lin SM, Hsu JY, Peng CCH, Munir KM, Wu TY, Yeh JI, Loh CH, Tu YK. Risk of developing diabetes in patients with atrial fibrillation taking non-vitamin K antagonist oral anticoagulants or warfarin: A nationwide cohort study. Diabetes Obes Metab 2021; 23:499-507. [PMID: 33140538 DOI: 10.1111/dom.14243] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 01/21/2023]
Abstract
AIM To compare the risk of diabetes development in patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin. MATERIALS AND METHODS We conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database. Adult patients with new onset of AF, treated with NOACs or warfarin between 2012 and 2016, were included. The NOAC cohort was further divided into dabigatran, rivaroxaban and apixaban groups. The primary outcome was incident diabetes requiring treatment with antidiabetic drugs. Fine and Gray subdistribution hazards models were used to estimate the adjusted hazard ratio (aHR). Propensity score matching was performed for each head-to-head comparison. RESULTS A total of 10 746 new-onset AF patients were included in our study. During the mean 2.4-year follow-up, NOACs were associated with a lower risk of developing diabetes than warfarin (aHR = 0.80, 95% confidence interval [CI]: 0.68-0.94, P = .007). Subgroup analyses confirmed that dabigatran, rivaroxaban and apixaban each had a reduced diabetes risk. Stratified analyses showed that the lower risk of diabetes associated with NOAC treatment was specific to patients aged 65 years or older (aHR = 0.74, 95% CI: 0.62-0.89, P = .002) and those with good medication adherence (aHR = 0.70, 95% CI: 0.58-0.84, P < .001). CONCLUSIONS Taking an NOAC was associated with a lower risk of developing diabetes than taking warfarin in patients with AF.
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Affiliation(s)
- Huei-Kai Huang
- Departments of Family Medicine and Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Peter Pin-Sung Liu
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shu-Man Lin
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jin-Yi Hsu
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Carol Chiung-Hui Peng
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA
| | - Kashif M Munir
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ting-Yu Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jih-I Yeh
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Hui Loh
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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25
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Patil T, Hobson J. Risk of new-onset osteoporosis in single-center veteran population receiving direct oral anticoagulants versus warfarin. Thromb Res 2021; 200:56-63. [PMID: 33540293 DOI: 10.1016/j.thromres.2021.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral anticoagulants (OAC) have shown to affect bone mineral density and cause osteoporosis. Limited studies have investigated the relationship between its use and risk of osteoporosis. We aim to compare the risk of osteoporosis in patients on warfarin versus direct oral anticoagulants (DOACs). METHODS A retrospective single-center cohort study was conducted in veterans age > 18 years of age in whom warfarin or DOACs were newly initiated between January 1st, 2012 to April 1st, 2020 at Salem VA Medical Center. Patients on OAC for at least 90 days qualified for inclusion and excluded if they were pregnant or had history of mechanical valve and mitral stenosis, on edoxaban or had previous history of osteoporosis or use of antiosteoporosis medication. Primary outcome was comparing incidence of new-onset osteoporosis between warfarin and DOACs. Secondary outcomes included comparing incidence of all clinical fractures, hip fractures, major bleeding and intracranial bleed between the treatments. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CI) comparing the two treatment groups were calculated. RESULTS A total of 1526 patients on DOAC and 1121 in warfarin group were included in the study. After propensity-score (PS) matching, 943 patients were included in each arm. Baseline characteristics were similar after PS-matching. DOAC treatment was associated with lower incidence of new-onset osteoporosis as compared to warfarin in matched cohort (aHR: 0.19, 95% CI: 0.10-0.36; p < 0.0001). The risk of all clinical fracture and hip fracture was similar in patients receiving DOACs as versus warfarin (aHR: 1.18, 95% CI: 0.82-1.69; p = 0.3671). DOAC use was associated with lower risk of major bleed (aHR: 0.07, 95% CI: 0.03-0.15; p < 0.0001) and intracranial bleed (aHR: 0.14, 95% CI: 0.03-0.64; p = 0.0111). CONCLUSION Overall, as compared to warfarin, prolonged use of DOACs is associated with lower risk of new-onset osteoporosis. We hope that our study findings will enlighten current clinical practices assuring safe use of OAC in veteran patients.
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Affiliation(s)
- Tanvi Patil
- Anticoagulation Program Manager, Clinical Pharmacy Specialist, Salem Veterans Affair Medical Center, Department of Pharmacy, Salem, Virginia.
| | - Jesse Hobson
- Salem Veterans Affair Medical Center, Quality Management-Program Analyst
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Chou MC, Huang JY, Hung YM, Perng WT, Chang R, Wei JCC. Flat foot and spinal degeneration: Evidence from nationwide population-based cohort study. J Formos Med Assoc 2021; 120:1897-1906. [PMID: 33423898 DOI: 10.1016/j.jfma.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/13/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE Flat foot can alter the lower limb alignment and cause knee and back pain. To explore the association between flat foot and spinal degeneration. METHODS By using a claims dataset containing 1 million random samples, individuals with flat foot were identified between January 1, 2000, and December 31, 2013. The study assembled a flat foot group and a matched non-flat foot group. Definition of flat foot was according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The diagnosis date was defined as the index date for follow-up initiation. The follow-up period was defined as the duration from the index date (or nested index date for controls) to the occurrence of spinal degenerative joint disease (DJD), or December 31, 2013. The primary outcome was record of spinal DJD retrieved from the same database. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with the control group as a reference. RESULTS We identified 13,965 patients (most aged <30 years, 88%); 2793 patients were assigned to the flat foot group and 11,172 individuals to the non-flat foot group matched by age, sex, and index year. The mean follow-up duration was approximately 74 months. In total, 329 (11.78%) patients in the study group and 931 (8.33%) patients in the comparison group developed spinal DJD. The adjusted HR (95% CI) of spinal DJD for study group was 1.423(1.250-1.619) compared with the control. Sensitivity analyses with propensity score match and different scenario about spinal DJD enrollment showed similar results. Subgroup analysis showed that in patients aged >45 years with history of flat foot, the adjusted hazard ratios were 1.434, 3.065, 3.110, and 2.061 in association with spondylosis, intervertebral disc disorder, cervical stenosis, thoracic-lumbar-sacral stenosis, respectively. CONCLUSION Flat foot was found to be an independent risk factor for subsequent spinal DJD.
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Affiliation(s)
- Mei-Chia Chou
- Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan; Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung, Taiwan; Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung, Taiwan.
| | - Jing-Yang Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Yao-Min Hung
- Office for Medical Education and Research, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Senior Citizen Service Management, Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan.
| | - Wuu-Tsun Perng
- Department of Recreational Sport & Health Promotion, National Pingtung University of Science and Technology, Pingtung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan.
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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27
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De Caterina R, Mundi S, Fusaro M. Vitamin K antagonists and osteoporotic fractures: insights from comparisons with the NOACs. Eur Heart J 2021; 41:1109-1111. [PMID: 32083296 DOI: 10.1093/eurheartj/ehaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
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Affiliation(s)
- Raffaele De Caterina
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa; and Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy
| | - Santa Mundi
- National Research Council (CNR) Institute of Clinical Physiology, Lecce, Italy and Dipartimento di Scienze e Tecnologie Biologiche ed Ambientali (DiSTeBA), University of Salento, Lecce, Italy
| | - Maria Fusaro
- CNR Institute of Clinical Physiology (IFC), Pisa, Italy and Dipartimento di Medicina, University of Padova, Italy
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28
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Katano S, Yano T, Tsukada T, Kouzu H, Honma S, Inoue T, Takamura Y, Nagaoka R, Ishigo T, Watanabe A, Ohori K, Koyama M, Nagano N, Fujito T, Nishikawa R, Takashima H, Hashimoto A, Katayose M, Miura T. Clinical Risk Factors and Prognostic Impact of Osteoporosis in Patients With Chronic Heart Failure. Circ J 2020; 84:2224-2234. [PMID: 33116003 DOI: 10.1253/circj.cj-20-0593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical significance of osteoporosis in chronic heart failure (CHF) remains unclear.Methods and Results:A total of 303 CHF patients (75 years, [interquartile range (IQR) 66-82 years]; 41% female) were retrospectively examined. Bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by using dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when the BMD at any of the 3 sites was <70% of the Young Adult Mean percentage (%YAM). The prevalence of osteoporosis in CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74-86] vs. 72 [IQR, 62-80] years), included a large percentage of females, had slower gait speed and had a lower body mass index. Multivariate logistic regression analysis indicated that sex, BMI, gait speed, loop diuretics use and no use of direct oral anticoagulants (DOACs) were independently associated with osteoporosis. Kaplan-Meier survival curves showed that the rate of death and heart failure hospitalization was higher in patients with osteoporotic BMD at 2 or 3 sites than in patients without osteoporosis (hazard ratio 3.45, P<0.01). In multivariate Cox regression analyses, osteoporotic BMD at 2 or 3 sites was an independent predictor of adverse events after adjustment for prognostic markers. CONCLUSIONS Loop diuretics use and no DOACs use are independently associated with osteoporosis in CHF patients. Osteoporosis is a novel predictor of worse outcome in patients with CHF.
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Affiliation(s)
- Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takanori Tsukada
- Cardiac Rehabilitation Center, Social Welfare Corporation, Hokkaido Social Work Association Obihiro Hospital
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Suguru Honma
- Department of Rehabilitation, Sapporo Cardiovascular Hospital
| | - Takuya Inoue
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Yuhei Takamura
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Ayako Watanabe
- Division of Nursing, Sapporo Medical University Hospital
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Department of Cardiology, Hokkaido Cardiovascular Hospital
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Division of Health Care Administration and Management, Sapporo Medical University School of Medicine
| | - Masaki Katayose
- Department of Public Health, Sapporo Medical University School of Medicine.,Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
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29
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Marietta M, Coluccio V, Boriani G, Luppi M. Effects of Anti-vitamin k oral anticoagulants on bone and cardiovascular health. Eur J Intern Med 2020; 79:1-11. [PMID: 32553585 DOI: 10.1016/j.ejim.2020.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/01/2020] [Accepted: 05/21/2020] [Indexed: 12/16/2022]
Abstract
Vitamin K antagonist oral anticoagulants (VKAs) have been proven over 50 years to be highly effective and acceptably safe in many settings and are still used by millions of people worldwide. The main concern about the safety of VKAs regards the risk of bleeding, but there is accumulation evidence of their potentially negative effects beyond hemostasis. Indeed, VKAs impair the action of several Vitamin-K Dependent Proteins (VKDP), such as Bone Gla protein, Matrix Gla protein, Gas6 Protein, Periostin and Gla-Ric Protein, involved in bone and vascular metabolism, thus exerting a detrimental effect on bone and vascular health. Indeed, although the evidence regarding this issue is not compelling, it has been shown that VKAs use decreases bone mass density, increases the risk of bone fractures and accelerates the process of vascular and valvular calcification. Vascular calcification is a major concern in Chronic Kidney Disease (CKD) patients, also in absence of VKAs, because of mineral metabolism derangement, chronic inflammation and oxidative stress. Direct Oral AntiCoagulants (DOACs) do not affect VKDP involved in vascular and valvular calcification, and do not induce calcific valve degeneration in animal models, being a possible alternative to AVK for CKD patients. However, the efficacy and safety of DOACs in this population, suggested by some recent observations, requires confirmation by dedicated, randomized study. We reviewed here the effects of VKAs in bone and vascular health as compared to DOACs, in order to provide the physicians with some data useful to wisely choose the most suitable anticoagulant for every patient.
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Affiliation(s)
- Marco Marietta
- Hematology Unit, Azienda Ospedaliero-Universitaria, Modena, Italy.
| | - Valeria Coluccio
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Mario Luppi
- Hematology Unit, Azienda Ospedaliero-Universitaria, Modena, Italy; Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
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30
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Sugiyama T. An update on hip fracture risk associated with anticoagulant therapy: warfarin versus direct oral anticoagulants. Expert Opin Drug Saf 2020; 19:1219-1220. [PMID: 32795203 DOI: 10.1080/14740338.2020.1811230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Toshihiro Sugiyama
- Department of Orthopaedic Surgery, Saitama Medical University , Saitama, Japan
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31
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Lüscher TF. Optimizing management of atrial fibrillation: integrated care, blood pressure control, ablation, and left atrial appendix occlusion. Eur Heart J 2020; 41:2821-2825. [PMID: 33216915 DOI: 10.1093/eurheartj/ehaa676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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32
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Sugiyama T. Hip fracture risk in patients with atrial fibrillation receiving oral anticoagulants. Eur Heart J 2020; 41:2918. [PMID: 32380552 DOI: 10.1093/eurheartj/ehaa297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Toshihiro Sugiyama
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
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33
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He N, Dell'Aniello S, Zhai S, Suissa S, Renoux C. Risk of fracture in patients with non-valvular atrial fibrillation initiating direct oral anticoagulants vs. vitamin K antagonists. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:389-397. [PMID: 32722764 DOI: 10.1093/ehjcvp/pvaa094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/16/2020] [Accepted: 07/21/2020] [Indexed: 12/27/2022]
Abstract
AIMS To determine the risk of fracture associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF), accounting for cumulative duration of use. METHODS AND RESULTS Using Quebec administrative healthcare databases, we formed a cohort of all patients aged 40 years or older newly diagnosed with NVAF, who filled a first prescription for DOACs or VKAs between 2011 and 2014. Exposure was modelled as a time-varying variable whereby patients were considered unexposed up to 180 days of cumulative duration of use (to account for a biologically meaningful exposure) and exposed thereafter. The final cohort included 10 306 new users of DOACs and 15 357 new users of VKAs. After propensity score-based fine stratification and weighting, use of DOACs for 180 days or greater was associated with a 35% decreased risk of fracture [crude incidence rates 7.5 vs. 15.3 per 1000 person-years; adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.46-0.91] compared to VKA duration ≥180 days. Direct oral anticoagulants use was also associated with a lower risk of hip fracture (HR 0.51, 95% CI 0.31-0.86) compared with VKAs. There was no difference in the rate of fracture for shorter duration of use (HR 1.10; 95% CI 0.79-1.53). The risk was not modified by age, sex, chronic kidney disease, osteoporosis, history of fracture or falls. CONCLUSION Prolonged use of DOACs is associated with a lower risk of fracture compared with VKAs. These findings support the first-line recommendation for DOACs in patients with NVAF.
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Affiliation(s)
- Na He
- Department of Pharmacy, Peking University Third Hospital, 49 Huayuan North Road, Beijing 100191, China.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Sainte-Catherine Road, Montreal, Québec H3T 1E2, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Québec H3A 1A2, Canada
| | - Sophie Dell'Aniello
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Sainte-Catherine Road, Montreal, Québec H3T 1E2, Canada
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, 49 Huayuan North Road, Beijing 100191, China
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Sainte-Catherine Road, Montreal, Québec H3T 1E2, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Québec H3A 1A2, Canada
| | - Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Sainte-Catherine Road, Montreal, Québec H3T 1E2, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Québec H3A 1A2, Canada.,Department of Neurology and Neurosurgery, McGill University, 853 Sherbrooke Street West, Montreal, Québec H3A 0G5, Canada
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34
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Ostroumova OD, Goloborodova IV. Clinical and Pathophysiological Aspects of the Effect of Anticoagulants on Bone Tissue. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- O. D. Ostroumova
- Russian Medical Academy of Continuous Professional Education; I.M. Sechenov First Moscow State Medical University (Sechenov University)
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