Observational studyBMJ open respiratory research2026
COPD and vitamin K antagonism: a cohort study of 1-year all-cause mortality and risk of hospitalisation due to a severe exacerbation.
Observational study in BMJ open respiratory research, 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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7 authors.
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Abstract
backgroundVitamin K, through its role in the vitamin K-dependent activation of matrix-GLA-protein, has been suggested to have a lung-protective effect, though the mechanism is unknown. Chronic obstructive pulmonary disease (COPD) patients treated with vitamin K antagonists (VKAs) may lose this protection, thereby increasing their risk of an acute exacerbation of COPD (AE-COPD) and death. We examined this hypothesis in a nationwide cohort of COPD patients treated with VKA. COPD patients treated with direct oral anticoagulant (DOAC) served as controls.
objectiveTo assess the association between VKA treatment and the 1-year risk of AE-COPD-related hospitalisation and all-cause mortality in patients with COPD and atrial fibrillation or flutter.
methodsThis nationwide, observational, register-based cohort study applied Cox proportional hazard regression models, adjusting for established confounders. HRs with 95% CIs were reported. Sensitivity analyses included complete-case analysis and inverse probability of treatment weighting (IPTW).
resultsA total of 7091 COPD patients were included, of whom 3455 (48.7%) received VKA treatment. A total of 1955 patients reached the endpoint, including 820 in the VKA-treated group. In the primary analysis, VKA treatment was associated with a lower risk of AE-COPD hospitalisation or death (adjusted HR of 0.87 (95% CI 0.78 to 0.98), p=0.024). The association remained in the sensitivity analyses but lost statistical significance. Complete-case analysis: adjusted HR of 0.88 (CI 0.76 to 1.01), p=0.079. IPTW analysis: HR of 0.85 (CI 0.72 to 1.01), p=0.070.
interpretationVKA treatment was associated with a reduction in risk of AE-COPD hospitalisation and mortality compared to DOAC. Sensitivity analysis was consistent with the main analysis; however, it did not reach statistical significance.
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