ArticleAmerican journal of epidemiology2026
Comparative risk of nonvertebral fractures associated with oral anticoagulants in patients with venous thromboembolism.
Article in American journal of epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Oral anticoagulants are widely used to prevent recurrence in patients with venous thromboembolism (VTE), but studies of these drugs in patients with atrial fibrillation have raised concerns that warfarin may be associated with higher risk of fractures than direct oral anticoagulants. Using the United States administrative claims data from Medicare and Optum Clinformatics (January 2016 to June 2024), we conducted a cohort study that emulated a three-arm target trial of VTE patients who initiated apixaban (N = 73 668), rivaroxaban (N = 30 849), or warfarin (N = 20 872). The primary outcome was nonvertebral fractures. Propensity score matching weights were used to balance baseline covariates. Patients were followed while on treatment; intention-to-treat (ITT) analyses were also conducted. Weighted hazard ratios while on treatment were 1.12 (95% CI, 0.89-1.41) for apixaban vs. warfarin, 1.13 (95% CI, 0.87-1.46) for rivaroxaban vs. warfarin, and 0.99 (95% CI, 0.80-1.23) for apixaban vs rivaroxaban. Results were consistent for ITT and other sensitivity analyses and across subgroups of age, sex, osteoporosis, and chronic kidney disease. Our findings suggest that apixaban, rivaroxaban, and warfarin are comparable with regards to nonvertebral fracture risk when used for VTE secondary prevention.
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