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Dig Liver Dis. 2019 Apr;51(4):489-495. doi: 10.1016/j.dld.2018.12.001. Epub 2018 Dec 13.

Efficacy and safety of anticoagulation for atrial fibrillation in patients with cirrhosis: A systematic review and meta-analysis.

Author information

1
Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. Electronic address: drronpichaic@gmail.com.
2
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
3
Department of Internal Medicine, University of Arizona, Tucson, AZ, USA.
4
Department of Medicine, University of Mississippi Medical Center, MS, USA.
5
Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA.
6
Department of Internal Medicine, Bassett Medical Center, NY, USA.
7
Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
8
Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
9
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.

Abstract

OBJECTIVE:

The atrial fibrillation-related stroke is clearly prevented by anticoagulation treatment, however, management of anticoagulation for AF in patients with cirrhosis represents a challenge due to bleeding concerns. To address this issue, a systematic review and meta-analysis of the literature was performed.

METHODS:

A literature search for studies reporting the incidence of AF in patients with cirrhosis was conducted using MEDLINE, EMBASE and Cochrane Database, from inception through July 2018.

RESULTS:

7 cohort studies including 19,798 patients with AF and cirrhosis were identified. The use of anticoagulation (%) among included studies ranged from 8.3% to 53.9%. Anticoagulation use for AF in patients with cirrhosis was significantly associated with a reduced risk of stroke, with a pooled HR of 0.58 (95%CI: 0.35-0.96). When compared with no anticoagulation, the use of anticoagulation was not significantly associated with a higher risk of bleeding, with a pooled HR of 1.45 (95%CI: 0.96-2.17). Compared to warfarin, the use of direct oral anticoagulants (DOACs) was associated with a lower risk of bleeding among AF patients with cirrhosis.

CONCLUSION:

Our study demonstrates that anticoagulation use for AF in patients with cirrhosis is associated with a reduced risk of stroke, without increasing significantly the risk of bleeding, when compared to those without anticoagulation.

KEYWORDS:

Anticoagulation; Atrial fibrillation; Cirrhosis; Liver failure; Meta-analysis; Systematic review

PMID:
30594462
DOI:
10.1016/j.dld.2018.12.001
[Indexed for MEDLINE]

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