Why the study?
Oral anticoagulants may reduce the risk of hepatic decompensation in patients with compensated cirrhosis, but well-powered randomized trials are lacking.
Do oral anticoagulants reduce the risk of hepatic decompensation and major bleeding in patients with compensated cirrhosis and atrial fibrillation?
Population
1,160 patients with compensated cirrhosis and newly diagnosed atrial fibrillation in Sweden
Comparison
Initiators vs non-initiators of oral anticoagulants
Design
Observational target trial emulation study
Follow-up
5 years
Key result
Initiation of oral anticoagulants in patients with compensated cirrhosis and atrial fibrillation reduced the 5-year risk of hepatic decompensation by 38% (RR 0.62) compared to non-initiators.
Authors
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Should not yet change practice in compensated cirrhosis with AF; leaves open need for randomized confirmation of decompensation benefit.
Observational (n=1,160)
Do oral anticoagulants reduce the risk of hepatic decompensation and major bleeding in patients with compensated cirrhosis and atrial fibrillation?
Relative Risk: 0.62 (95% CI 0.33–0.92)
Absolute Event Rate: 10.4% vs 16.6%
Absolute Risk Reduction: 6.2%
Number Needed to Treat: 17
In patients with compensated cirrhosis and atrial fibrillation, initiating oral anticoagulants is associated with a reduced risk of hepatic decompensation without increasing the risk of major bleeding.
Wester et al. (2026) conducted an observational in Compensated cirrhosis and atrial fibrillation (n=1,160). Oral anticoagulants vs. Non-initiators was evaluated on First hepatic decompensation during follow-up (RR 0.62, 95% CI 0.33-0.92). Initiation of oral anticoagulants in patients with compensated cirrhosis and atrial fibrillation reduced the 5-year risk of hepatic decompensation by 38% (RR 0.62) compared to non-initiators.