Liver Cirrhosis in Patients With Atrial Fibrillation: Would Oral Anticoagulation Have a Net Clinical Benefit for Stroke Prevention?

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  Figure 1. A flowchart of the enrollment of the study cohort. From January 1, 2000 to December 31, 2011, a total of 289 559 AF patients aged ≥20 years (10 336 with liver cirrhosis) were identified from the NHIRD. The risks of ischemic stroke and ICH were compared for patients with and without liver cirrhosis. Among 10 336 patients with liver cirrhosis, 9056 had a CHA 2 DS 2‐VASc score ≥2. These were divided into 3 groups, that is, no treatment (61.1%), antiplatelet therapy (30.6%), and warfarin (8.3%). The risk of ICH and benefit of stroke risk reduction were analyzed between patients without use of any anti‐thrombotic agent and those with anti‐platelet agents or warfarin use. AF indicates atrial fibrillation; ICH, intracranial hemorrhage; NHIRD, National Health Insurance Research Database.

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  Figure 2. Risk of ischemic stroke and ICH for AF patients with or without liver cirrhosis, stratified based on the strategies for stroke prevention. For patients who did not receive antithrombotic therapies, the risk of ischemic stroke and ICH was higher for AF patients with liver cirrhosis compared with those without. For patients treated with warfarin, the risk of ischemic stroke and ICH was similar between patients with or without liver cirrhosis. The hazard ratio was adjusted for age, sex, CHA 2 DS 2‐VASc score, COPD, hyperlipidemia, malignancy, autoimmune diseases, end‐stage renal disease, degree of urbanization, and income level. CI indicates confidence interval; ICH, intracranial hemorrhage.