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In a recent observational study, direct oral anticoagulants (DOACs) were associated with a lower risk for bone fractures than warfarin (NEJM JW Cardiol Nov 6 2019 and J Am Coll Cardiol 2019; 74:2150). Now, in perhaps the largest cohort study of its type, researchers analyzed administrative commercial claims databases (January 2010–September 2015) to evaluate fracture risk in patients with nonvalvular atrial fibrillation who were prescribed an anticoagulant.
The 167,275 patients (38% women; mean age, 69) were propensity-score–matched and grouped by the first type of anticoagulant received. There were 817 hip fractures, 2013 fractures necessitating hospitalization, and 7294 total fractures during a mean follow-up of 17 months. In multivariable…