Ronpichai Chokesuwattanaskul1, Charat Thongprayoon2, Tarun Bathini3, Aldo Torres-Ortiz4, Oisin A O'Corragain5, Kanramon Watthanasuntorn6, Ploypin Lertjitbanjong6, Konika Sharma6, Somchai Prechawat7, Patompong Ungprasert8, Paul T Kröner9, Karn Wijarnpreecha9, Wisit Cheungpasitporn4. 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.
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 AFpatients 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.
Authors: Marina Serper; Ethan M Weinberg; Jordana B Cohen; Peter P Reese; Tamar H Taddei; David E Kaplan Journal: Hepatology Date: 2020-11-09 Impact factor: 17.425
Authors: Sarah A Nisly; Alexandra E Mihm; Chris Gillette; Kyle A Davis; Janine Tillett Journal: J Thromb Thrombolysis Date: 2021-03-16 Impact factor: 2.300