MONDAY, Nov. 16, 2020 — For adults with atrial fibrillation, warfarin is associated with an increased risk for knee and hip replacements for osteoarthritis (OA), according to a study presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9.
Priyanka Ballal, M.D., from the Boston University School of Medicine, and colleagues conducted a nested case-control study using the Health Improvement Network to examine the association between warfarin and risk for knee and hip replacements among adults aged 40 to 89 years with atrial fibrillation. Cases with knee replacement (KR) or hip replacement (HR) between 2014 and 2018 were identified; each case was age- and gender-matched with up to four controls (913 cases and 3,652 controls, respectively). The relation of warfarin versus direct oral anticoagulant (DOAC) use with the risk for KR or HR was assessed.
The researchers found that warfarin users had increased odds of KR or HR versus DOAC users after adjustment for potential confounders (adjusted odds ratio, 1.57). The association was slightly attenuated but remained significant with matching by practice identification to account for practice variation (adjusted odds ratio, 1.25). The risk for KR or HR increased with duration of warfarin versus DOAC exposure.
“Our research supports the importance of adequate vitamin K and dependent proteins for limiting progression of OA,” Ballal said in a statement. “Given these potential adverse effects of warfarin on joint health, our study suggests that direct oral anticoagulants could be considered for managing atrial fibrillation among patients who have OA.”
One author disclosed financial ties to the pharmaceutical industry.
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