Key result
Oral anticoagulation remains warranted in AF with liver disease as stroke risk outweighs bleeding risk.
Why the study?
Anticoagulation for atrial fibrillation in patients with liver disease is challenging due to altered coagulation, increased major bleeding risk, and complex anticoagulation monitoring.
Does oral anticoagulation safely prevent ischemic stroke in patients with atrial fibrillation and liver disease?
Does oral anticoagulation safely prevent ischemic stroke in patients with atrial fibrillation and liver disease?
Despite the increased bleeding risk and monitoring challenges, anticoagulation is generally favored for stroke prevention in patients with atrial fibrillation and liver disease.
Supports anticoagulation consideration in AF with liver disease; leaves open need for randomized trials to confirm net benefit.
Atrial fibrillation is associated with significant morbidity and mortality, and its incidence is increasing globally. The primary complication of atrial fibrillation is ischemic stroke, whose risk may be reduced with oral anticoagulant agents, i.e., either vitamin K antagonists or direct oral anticoagulants. Patients with atrial fibrillation often have concomitant hepatic impairment, particularly because of increasing rates of non-alcoholic liver disease. However, anticoagulation in patients with liver disease is challenging due to the pathophysiological changes of the coagulation cascade and, as a result, an increased risk of major bleeding in such individuals. Furthermore, monitoring of the degree of anticoagulation is complicated in patients with liver disease due to issues such as spontaneous international normalized ratio (INR) elevation, changes in hepatic drug elimination, and thrombocytopenia. We review the current evidence on atrial fibrillation and anticoagulation in patients with liver disease. We suggest having a strong focus on risk factor management and argue that the risk of ischemic stroke often outweighs the risk of hemorrhagic events in this setting.
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Godtfredsen et al. (2023) conducted a review in Atrial fibrillation and liver disease. Oral anticoagulants was evaluated. Oral anticoagulation in patients with atrial fibrillation and liver disease is challenging but often warranted, as the risk of ischemic stroke generally outweighs the risk of hemorrhagic events.
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