ArticleFrontiers in cardiovascular medicine2022
Comparative Risks of Fracture Among Direct Oral Anticoagulants and Warfarin: A Systematic Review and Network Meta-Analysis.
Article in Frontiers in cardiovascular medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 9 citations in OpenAlex.
- Review
- Comparative risk of nonvertebral fractures associated with oral anticoagulants in patients with venous thromboembolism.American journal of epidemiology · 2026Article
- Impact of a history of falls on clinical outcomes in older adult non-valvular atrial fibrillation patients: an ANAFIE registry study.BMC geriatrics · 2026Observational
- Drug-Induced Osteoporosis.Journal of clinical medicine · 2026Review
- Exploring Fall-Related Fracture Risk by Possible Fall-Risk Increasing Drugs in Japanese Older Adults Using Municipal Linked Medical and Long-Term Care Claim Data: A Nested Case-Control and Case-Crossover Study.Geriatrics & gerontology international · 2025Article
- Comparative risk of osteoporotic fractures with direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients: a systematic review.International journal of burns and trauma · 2025Review
- Effect of direct oral anticoagulant dabigatran on early bone healing: An experimental study in rats.Journal of advanced periodontology & implant dentistry · 2023Article
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
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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