In patients with atrial fibrillation and liver disease, oral anticoagulant use was associated with a reduced risk of stroke (HR 0.80; 95% CI 0.70-0.92), major bleeding, and all-cause death.
Cohort (n=393,507)
Yes
Does oral anticoagulant therapy reduce stroke, major bleeding, and all-cause death in patients with atrial fibrillation and concomitant liver disease?
In patients with atrial fibrillation and concomitant liver disease, oral anticoagulant use is associated with a net clinical benefit, reducing the risks of stroke, major bleeding, and all-cause death.
Hazard Ratio: 0.8 (95% CI 0.7–0.92)
AIMS: Data on the impact of liver disease (LD) in patients with atrial fibrillation (AF) and the role of oral anticoagulant (OAC) drugs for stroke prevention are limited. METHODS AND RESULTS: A retrospective observational population-based cohort study on the administrative health databases of Lombardy region Italy. All AF patients ≥40 years admitted to hospital from 2000 to 2018 were considered. Atrial fibrillation and LD diagnosis were established using ICD9-CM codes. Use of OAC was determined with Anatomical Therapeutic Chemical codes. Primary study outcomes were stroke, major bleeding, and all-cause death. Among 393 507 AF patients, 16 168 (4.1%) had concomitant LD. Liver disease AF patients were significantly less treated with OAC. Concomitant LD was associated with an increased risk in all the study outcomes hazard ratio (HR): 1.18, 95% confidence interval (CI): 1.11-1.25 for stroke; HR: 1.57, 95% CI: 1.47-1.66 for major bleeding; HR: 1.41, 95% CI: 1.39-1.44 for all-cause death. Use of OAC in patients with AF and LD resulted in a reduction in stroke (HR: 0.80, 95% CI: 0.70-0.92), major bleeding (HR: 0.86, 95% CI: 0.74-0.99), and all-cause death (HR: 0.77, 95% CI: 0.73-0.80), with similar results according to subgroups. A net clinical benefit (NCB) analysis suggested a positive benefit/risk ratio in using OAC in AF patients with LD (NCB: 0.408, 95% CI: 0.375-0.472). CONCLUSION: In AF patients, concomitant LD carries a significantly higher risk for all clinical outcomes. Use of OAC in AF patients with LD was associated with a significant favourable benefit/risk ratio, even in high-risk patient subgroups.
Proietti et al. (Fri,) conducted a cohort in Atrial fibrillation and liver disease (n=393,507). Oral anticoagulant (OAC) vs. No OAC was evaluated on Stroke (HR 0.80, 95% CI 0.70-0.92). In patients with atrial fibrillation and liver disease, oral anticoagulant use was associated with a reduced risk of stroke (HR 0.80; 95% CI 0.70-0.92), major bleeding, and all-cause death.
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