Journal: Eur Heart J Cardiovasc Pharmacother

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Abstract

Anticoagulation in atrial fibrillation and liver disease: a pooled-analysis of > 20000 patients.

Chen S, Pürerfellner H, Meyer C, Sommer P, ... Chun JKR, Schmidt B
Aims
Anticoagulation for atrial-fibrillation (AF) patients with liver-disease represents a clinical dilemma. We sought to evaluate the efficacy/safety of different anticoagulation, i.e. vitamin-K-antagonist (VKA) and non-VKA oral-anticoagulants (NOACs) in such patient group.
Methods and results
This was a pooled-analysis enrolling up-to-date clinical data. Two subsets: subset A (VKA vs. Non-Anticoagulation) and subset B (NOACs vs. VKA) were pre-specified. The study outcomes were ischemic-stroke(IS)/thromboembolism(TE), major-bleeding (MB), intracranial-bleeding (ICB), gastrointestinal-bleeding (GIB) and all-cause mortality.A total of 20,042 patients\' data were analyzed (subset A: N = 10275, subset B: N = 9767). Overall mean age: 71±11 years, mean CHA2DS2-VASc score: 4.0±1.8, mean HAS-BLED score: 3.6±1.2. The majority of the patients had Child-Pugh category (A-B). As compared with Non-Anticoagulation, VKA seemed to reduce the risk of IS/TE (OR: 0.60, P = 0.05), but heighten the risk of all-bleeding-events including MB (OR: 2.81, P = 0.01), ICB (OR: 1.60, P = 0.01), and GIB (OR: 3.32, P = 0.01). When compared with VKA, NOACs had similar efficacy in reducing the risk of IS/TE (OR: 0.82, P = 0.64), significantly lower risk of MB (OR: 0.54, P = 0.0003) and ICB (OR: 0.35, P < 0.0001), and trend towards reduced risk of GIB (OR: 0.72, P = 0.12) and all-cause mortality (OR: 0.79, P = 0.35). The favorable effects were maintained in subgroups of individual NOAC.
Conclusions
VKA appears to reduce the risk of IS/TE but increase all-bleeding-events. NOACs have similar effect in reducing the risk of IS/TE and have significantly lower risk of MB and ICB as compared with VKA. NOACs seem to be associated with better clinical outcome than VKA in patients with mild-moderate liver disease.

© Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2021. For permissions, please email: [email protected]

Eur Heart J Cardiovasc Pharmacother: 18 Apr 2021; epub ahead of print
Chen S, Pürerfellner H, Meyer C, Sommer P, ... Chun JKR, Schmidt B
Eur Heart J Cardiovasc Pharmacother: 18 Apr 2021; epub ahead of print | PMID: 33871577
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This program is still in alpha version.