Warfarin is associated with a raised risk of fracture compared with non-vitamin K antagonist oral anticoagulants (NOACs), a large real-world study has found.

The US researchers evaluated the safety of warfarin versus NOACs in relation to fracture risk in more than 167,000 patients (mean age 69, and 62% men) with non-valvular AF who were prescribed one of the oral anticoagulants over a six-year period.

Overall, 49% were treated with warfarin and 51% with a NOAC — 11% received apixaban, 19% dabigatran and 21% rivaroxaban.

On average, at the follow-up at 16.9 months, 7294 patients had had a clinical fracture.