Name:
Anticoagulants and Bone Health
Description:
Anticoagulants and Bone Health
Thumbnail URL:
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Duration:
T00H03M53S
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst The Heart Board Review, and other online resources available only through accesscardiology.com. >> As many people continue to age, osteoporosis has become quite common. Also associated with aging is the increase in the prevalence and incidence of atrial fibrillation. What have we learned about anti-coagulants and bone health? [ Music ] >> Hi, Dr. Bernie here, and welcome to Practice Impact Extra.
I want to present an October 2019 study published in the Journal of American College of Cardiology that assessed optimal blood thinners, anti-coagulants, and bone health. Does this study really have any practice impact value? Data reveals that there are more than 3 million Americans that have atrial fibrillation, with a greater incidence in the elderly. Atrial fibrillation, as you know, leads to greater use of anti-coagulants. An earlier study published in January 2016 from Washington University School of Medicine St. Louis reported the result of a retrospective study of 15,000 patients with atrial fibrillation treated with the vitamin K antagonist Warfarin.
Their analysis showed that long-term use of Warfarin, longer than one year, lead to a 25% increase in the incidence of fractures. This was thought to be secondary to vitamin K's interaction with osteocalcin, a protein vital for bone formation. Profound was a statement of one of the primary authors, and I quote, "My hope is for the development of anti-coagulants that do not inhibit vitamin K." Let's fast forward now.
We do have such anti-coagulations, and those are the NOACs. But do these newer blood thinners really lower the risk for fractures, particularly in the elderly, many of whom have osteoporosis? A study in JACC, the Journal American College of Cardiology, in December 2019 compared bone fractures among more than 37,000 older adults taking blood thinners for atrial fibrillation. The goal of the study? Assessing whether the type of bloods thinner given really affects the progression and development of osteoporosis and of broken bones.
One-third of these patients were taking vitamin K antagonists, and the other group were on NOACs. The follow up at two years found that patients on NOACs had a 15% lower risk of broken bones than those taking vitamin K antagonists. It must be noted, however, that the overall risk of broken bones was really quite low for both the active and study group. So what's my take on this? For the time being, NOACs appear to present a better safety profile compared to vitamin K antagonists, particularly for bone health.
I think that's another key factor to consider when choosing anticoagulation. I think it's also very important to review the American Heart and American College of Cardiology updated guidelines for the treatment of atrial fibrillation that were published in circulation in 2019. I want to thank you again for joining me, and see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features.
To subscribe or learn more, please visit accesscardiology.com.
