Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.
Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.
Bone. 2022 Mar;156:116303. doi: 10.1016/j.bone.2021.116303. Epub 2021 Dec 29.
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.
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.
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.
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.
与华法林相比，三种直接口服抗凝剂（DOAC）利伐沙班、阿哌沙班和达比加群与骨折风险降低相关。然而，尚无大规模研究探讨最新 DOAC 依度沙班与骨折风险的相关性。本研究旨在通过比较依度沙班与华法林使用者中新发髋部骨折的发生率，阐明依度沙班对老年患者髋部骨折风险的影响。
这是一项在中国香港进行的回顾性基于人群的队列研究，纳入了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间使用依度沙班或华法林的患者。排除了暴露时间不足 1 个月、华法林和依度沙班之间药物转换、药物暴露后 30 天内死亡、既往人类免疫缺陷病毒感染、年龄<50 岁以及既往髋部骨折的患者。采用最近邻匹配（1:2）法，基于人口统计学、既往合并症和不同药物的使用，对依度沙班和华法林使用者进行倾向评分匹配。研究结局为新发髋部骨折、有医疗记录的跌倒和全因死亡率。
共纳入 5014 例患者，包括 579 例依度沙班使用者和 4435 例华法林使用者（中位年龄 70 岁[四分位距（IQR）：62-79]，56.66%为男性），中位随访时间为 637.5（IQR：320-1073）天。在匹配队列中，依度沙班使用者新发髋部骨折、有医疗记录的跌倒和全因死亡率的发生率明显较低。与华法林相比，依度沙班使用者新发髋部骨折（风险比[HR]：0.13，95%置信区间[CI]：[0.03-0.54]，p=0.0051）、有医疗记录的跌倒（HR：0.47，[0.29-0.75]，p=0.0018）和全因死亡率（HR：0.61，[0.42-0.87]，p=0.0059）的风险降低具有保护作用。使用不同倾向评分方法进行的所有敏感性分析均表明，依度沙班与较低骨折风险之间的显著关系在匹配后仍然存在。
与华法林相比，依度沙班使用与新发髋部骨折、有医疗记录的跌倒和死亡率风险降低相关。
