TOPLINE:

In patients with chronic obstructive pulmonary disease (COPD) and atrial fibrillation or atrial flutter, treatment with vitamin K antagonists was associated with a lower 1-year risk for hospitalization due to an acute exacerbation of COPD and all-cause death than direct oral anticoagulants.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using data from linked registers to evaluate whether treatment with vitamin K antagonists vs direct oral anticoagulants was associated with the 1-year risks for hospitalization for an acute exacerbation of COPD and all-cause death in patients with COPD and atrial fibrillation or atrial flutter.
• They analyzed 7091 patients; of them, 3455 (mean age, 75.2 years; 63.5% men) received vitamin K antagonist treatment and 3636 (mean age, 76.1 years; 54.5% men) received direct oral anticoagulant treatment.
• Patients were considered to be exposed if they had a dispensed prescription for either a vitamin K antagonist or a direct oral anticoagulant within 6 months before cohort entry.
• The primary endpoint was a composite of hospitalization due to an acute exacerbation of COPD and all-cause mortality within 365 days of cohort entry; hospital admissions for exacerbations were identified using predefined diagnostic codes.

TAKEAWAY:

• Overall, 1955 patients — 820 in the vitamin K antagonist group and 1135 in the direct oral anticoagulant group — reached the composite endpoint within 365 days of cohort entry.
• Treatment with vitamin K antagonists was associated with a lower 1-year risk for the composite endpoint than treatment with direct oral anticoagulants (adjusted hazard ratio, 0.87; P = .024).
• In an analysis of patients with complete covariate data, the effect favoring vitamin K antagonist treatment was preserved but was no longer statistically significant.

IN PRACTICE:

“Our results suggest that COPD patients may be treated with VKAs [vitamin K antagonists] rather than DOACs [direct oral anticoagulants],” the authors wrote.

SOURCE:

This study was led by Bård-Emil Vang Vang Gundersen, Gentofte Hospital, Copenhagen, Denmark. It was published online on January 27, 2026, in BMJ Open Respiratory Research.

LIMITATIONS:

The study’s register-based design limited the ability to investigate the biological or treatment mechanisms underlying the findings. It did not examine between-group differences in major bleeding events, and comorbid conditions may have been underreported. The nonrandomized design may have introduced confounding.

DISCLOSURES:

This study was funded by the Novo Nordisk Foundation. One author reported receiving personal fees outside the submitted work. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.