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New research presented at ACR Convergence, the annual meeting of the American College of Rheumatology, shows that the use of warfarin, a vitamin K drug often prescribed to prevent blood clots, is beneficial in patients with osteoarthritis (ABSTRACT) is associated with a significantly higher risk of knee and hip replacement # 0934).
Osteoarthritis (OA) is a common joint disease that most commonly affects the elderly in middle age. It was commonly referred to as “wear and tear” of the joints, but we now know that OA is an entire joint disease involving cartilage, joint lining, ligaments and bones.
Vitamin K deficiency has been linked to OA and recent research shows that vitamin K supplementation can reduce the progression of OA. However, to date no studies have investigated whether vitamin K antagonism using warfarin, an anticoagulant, may be harmful to OA. This new study evaluated the relationship between warfarin, a commonly prescribed drug for atrial fibrillation – the management of tremulous or irregular heartbeats – with the risk of end-stage knee and hip replacement of OA.
“We hypothesized that disruption of the function of vitamin K-dependent bone and cartilage proteins through vitamin K antagonism may lead to abnormalities in chondrocyte function with negative effects on cartilage health, which in turn increases the risk. OA can develop or worsen. “says study co-author Priyanka Ballal, MD, a rheumatology colleague at Boston University Medical Center. “Since direct oral anticoagulants are alternative anticoagulant options that do not interfere with vitamin K function, clarifying this risk of warfarin would provide valuable information to providers and patients as they consider anticoagulation choices in patients with atrial fibrillation.”
The nested case-control study used data from the Health Improvement Network, a UK GP-based electronic health record database representative of the general population. The sample was limited to adults aged 40 to 89 with atrial fibrillation, as this diagnosis requires anticoagulant therapy. They compared warfarin, a vitamin K antagonist, with direct oral anticoagulants that do not inhibit vitamin K and were first marketed in the UK in 2008. Among other things, they ruled out anyone who had undergone surgery to replace the vitamin. knee or hip prior to 2014, anyone with severe comorbidities that would limit surgery, those taking warfarin or direct oral anticoagulants within a year prior to the study period, and anyone taking either drug used during the study period. They identified cases as people who had undergone knee or hip replacements between 2014 and 2018. Each case was compared to up to four controls for age and sex. Warfarin and direct oral anticoagulant use were defined as having one or more prescriptions after study entry and within one year of the index date.
The researchers assessed how warfarin posed the risk of knee or hip replacement compared to direct oral anticoagulants. The study included 913 patients with knee or hip replacement, four-to-one ratios adjusted for age and sex with 3,652 controls. Their average age was 74, and 46% were women. Of the 913 surgical cases, 64.9% were warfarin users and 35.1% were direct users of oral anticoagulants.
After correcting for potential confounding factors, they found that warfarin users were 1.57 times more likely to undergo a knee or hip replacement than direct oral anticoagulant users. They also found an increased risk of knee or hip replacement surgery with the duration of warfarin use compared with direct oral anticoagulant use.
The researchers point out that their data support the importance of having adequate vitamin K in limiting the progression of OA in patients and are considering the use of direct oral anticoagulants instead of warfarin when indicated or at risk for people. with OA The disease exists.
“Our research supports the importance of having enough vitamin K and dependent proteins in limiting the progression of OA,” says Dr. Ballal. “Given these potential adverse effects of warfarin on joint health, our study suggests that direct oral anticoagulants could be considered for the treatment of atrial fibrillation in patients with OA. Our group’s next research steps are design. and starting a randomized trial powerful enough to test the efficacy of vitamin K supplementation on OA outcomes. “
Supplied by
American College of Rheumatology.
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