Why the study?
Patients with AF and concurrent liver cirrhosis were excluded from major DOAC clinical trials due to safety concerns, leaving optimal anticoagulation uncertain in this high-risk population.
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism in patients with atrial fibrillation and liver cirrhosis compared to vitamin K antagonists?
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism in patients with atrial fibrillation and liver cirrhosis compared to vitamin K antagonists?
In patients with atrial fibrillation and liver cirrhosis, DOACs appear to be a safer and more effective alternative to VKAs, significantly reducing the risk of both thromboembolic events and major bleeding.
Supports preferring DOACs over VKAs in AF with cirrhosis; extends meta-analytic evidence to this population.
Patients with atrial fibrillation and concurrent liver cirrhosis have been excluded from major clinical trials evaluating direct oral anticoagulants (DOACs) due to safety concerns. This has led to uncertainty regarding the optimal anticoagulant therapy in this population at high risk of thromboembolic events. We conducted a systematic review and meta-analysis to compare the effectiveness and safety of DOACs versus vitamin K antagonists (VKAs) in patients with atrial fibrillation and liver cirrhosis. Databases including Embase, MEDLINE/PubMed, and Web of Science were searched for relevant studies. The primary effectiveness outcome was stroke or systemic embolism, and the safety outcome was major bleeding events. A total of 10 studies were included in the meta-analysis. Compared to VKAs, the use of DOACs was associated with a significantly lower risk of stroke or systemic embolism (RR: 0.78, 95% CI: 0.65-0.92, p=0.005). The risk of all-cause mortality was comparable between the two groups (RR: 0.89, 95% CI: 0.74-1.07, p=0.23). Notably, DOACs demonstrated a significantly lower risk of major bleeding events (RR: 0.67, 95% CI: 0.61-0.73, p<0.01) compared to VKAs. This meta-analysis suggests that DOACs may be a favorable alternative to VKAs for the prevention of thromboembolic events in patients with atrial fibrillation and liver cirrhosis, with a lower risk of stroke or systemic embolism and major bleeding. However, further research is needed to establish optimal dosing strategies and assess the safety and efficacy of DOACs in patients with advanced liver disease.
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Sinha et al. (2024) studied this question.
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