Key result
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.
Why the study?
Data on the impact of liver disease in patients with AF and the role of OAC drugs for stroke prevention are limited.
Does oral anticoagulant therapy reduce stroke, major bleeding, and all-cause death in patients with atrial fibrillation and concomitant liver disease?
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?
Hazard Ratio: 0.8 (95% CI 0.7–0.92)
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.
May support oral anticoagulant use in atrial fibrillation with liver disease; extends low-certainty observational data but leaves randomized confirmation open.
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.
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Proietti et al. (2020) 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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