UCL School of Pharmacy


UCL Co-led Study Finds Direct Oral Anticoagulants May Cut Fracture Risk Compared To Warfarin

19 May 2020

A joint UCL School of Pharmacy and University of Hong Kong (HKU) study has direct oral anticoagulants are associated with lower risks of osteoporotic fracture compared with warfarin for patients with atrial fibrillation.

Direct oral anticoagulants (DOAC) are associated with lower risk of osteoporotic fracture compared with warfarin for patients with atrial fibrillation (AF). No difference was found between DOACs for greater fracture reduction. Findings from a population-based cohort study have been published in Annals of Internal Medicine.

AF is the most common heart rhythm disorder in clinical practice, affecting over 33 million people worldwide. People with AF have a higher risk of ischemic stroke and are treated with anticoagulants to reduce their chances of developing such condition. Osteoporotic fracture is a known serious complication of anticoagulants among patients with AF. It is unclear whether anticoagulant type is associated with degree of risk.

Blood cells

Researchers from the UCL School of Pharmacy and The University of Hong Kong (HKU) studied an electronic health record database for patients newly diagnosed with AF between 2010 and 2017 who received a new prescription for warfarin or a direct oral anticoagulant (DOAC) (apixaban, dabigatran, or rivaroxaban) to compare risk for osteoporotic fracture between anticoagulants.

After a 24-month follow-up, the data showed that DOAC use was associated with a lower risk for fracture than warfarin use. No differences were seen in all head-to-head comparisons between DOACs at 24 months. According to the authors, these findings may help inform the benefit–risk assessment when choosing between anticoagulants.

The authors noted that osteoporotic fracture and AF share many common risk factors such as older age, high blood pressure, and diabetes; but in practice, the risk of osteoporotic fractures is often neglected when choosing an oral anticoagulant. If DOAC use could result in a lower risk fracture than warfarin use, patients who are eligible for both treatments could be prescribed DOAC rather than warfarin to reduce their risks of developing osteoporotic fracture.

This is a research output of the strategic collaboration between UCL and HKU on Medication Safety Research and Big Data Science (The University of Hong Kong and University College London Strategic Partnership Fund).

Further information:

Read the abstract here
Department of Pharmacology and Pharmacy of  HKU


Dr Wallis Lau - staff profile Twitter profile - @Wallis_Lau 
Dr Kenneth Man - staff profile Twitter profile - @KennethKCMan
Professor Ian Wong - staff profile  Twitter profile - @Ian_HKU