Warfarin use and risk of knee and hip replacements

Priyanka Ballal, Christine Peloquin, Cindy Germaine Boer, Tuhina Neogi*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Scopus)
16 Downloads (Pure)


Background Identification of modifiable risk factors and treatments for osteoarthritis (OA) are needed. Warfarin, a vitamin K antagonist, causes fetal and animal model skeletal abnormalities. Vitamin K insufficiency has been associated with OA, but whether warfarin is also detrimental to OA is not known. Methods We conducted a nested case-control study using a UK general practitioner electronic medical records database. We identified cases of knee or hip replacement (KR or HR) from among adults with atrial fibrillation newly prescribed either warfarin or direct oral anticoagulants (DOACs). Cases were matched with four controls by age and sex. We assessed the relation of warfarin compared with DOAC use to risk of joint replacement using conditional logistic regression. We also evaluated different durations of warfarin use. Results We identified 857 subjects with KR or HR (cases), of whom 64.6% were warfarin users, and 3428 matched controls, of whom 56.1% were warfarin users (mean age 75, 47% female). Warfarin users had a 1.59 times higher risk of joint replacement thanDOAC users (adjusted OR 1.59, 95% CI 1.31 to 1.92). Longer duration of warfarin use was associated with higher risk of joint replacement in comparison with <1 year of warfarin use. Conclusion Warfarin, a vitamin K antagonist, was associated with greater risk of KR and HR (an indicator for end-stage knee OA) than DOAC use, supporting the importance of adequate vitamin K functioning in limiting OA progression.

Original languageEnglish
Pages (from-to)605-609
Number of pages5
JournalAnnals of the Rheumatic Diseases
Issue number5
Publication statusPublished - 12 Apr 2021

Bibliographical note

Funding: This work and CP were supported by NIH P30AR072571. TN was supported by NIH K24AR070892. Sponsors played no role in the conduct of the study or preparation of this manuscript. Competing interests None declared. Patient consent for publication Not required.

Publisher Copyright: © 2021 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.


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