Key result
Direct-acting oral anticoagulants demonstrate comparable efficacy and a potentially lower risk of major bleeding compared to vitamin K antagonists in patients with non-valvular atrial fibrillation and compensated liver cirrhosis.
Why the study?
Cirrhosis carries elevated risks of both thrombosis and bleeding, and clinical experience and evidence regarding DOAC efficacy and safety in liver cirrhosis with AF remain limited.
What is the efficacy and safety of DOACs and traditional antithrombotic agents in patients with atrial fibrillation and liver cirrhosis?
What is the efficacy and safety of DOACs and traditional antithrombotic agents in patients with atrial fibrillation and liver cirrhosis?
This review highlights the challenges and summarizes the current evidence regarding the use of DOACs and traditional anticoagulants in patients with concurrent atrial fibrillation and liver cirrhosis, a population at elevated risk for both thrombosis and bleeding.
Answers are grounded in this paper and cite their sources.
Anticoagulation decisions in AF with cirrhosis remain complex; leaves open optimal DOAC strategies for dedicated trials.
Atrial fibrillation (AF) is an increasingly recognized comorbidity in patients with liver cirrhosis, mainly associated with nonalcoholic fatty liver disease and alcohol-associated liver disease, affecting the quality of life and prognosis. On the other hand, cirrhosis is associated with an elevated risk of both thrombosis and bleeding, making the decision about anticoagulation therapy very challenging. Direct-acting oral anticoagulants (DOACs) are approved for patients with non-valvular AF. However, there is limited clinical experience and scientific evidence about their efficacy and safety in liver cirrhosis. This review article investigates the published literature concerning the administration of DOACs and traditional antithrombotic agents, such as vitamin K antagonists and heparins, in patients with liver cirrhosis and AF.
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Eleni Karapedi (2022) conducted a review in Atrial fibrillation and liver cirrhosis. Direct-acting oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) or no anticoagulation was evaluated. Direct-acting oral anticoagulants demonstrate comparable efficacy and a potentially lower risk of major bleeding compared to vitamin K antagonists in patients with non-valvular atrial fibrillation and compensated liver cirrhosis.
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