Jiaxi Zhao1,2, Joseph E Blais1, Celine S L Chui1, In-Hye Suh1, Esa Y H Chen3, Wai-Kay Seto4,5,6, Michael T Mok7, Vincent K C Yan1, Wallis C Y Lau1,8, Ian C K Wong1,8, Esther W Chan1,2. 1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. 2. The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China. 3. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia. 4. Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. 5. State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong SAR, China. 6. Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. 7. Department of Cardiology, University Hospital Geelong and Deakin University, Geelong, Victoria, Australia. 8. Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
Abstract
INTRODUCTION: The risk of liver injury in patients with atrial fibrillation (AF) using nonvitamin K antagonist oral anticoagulants (NOACs) has not been previously examined using liver function tests as the primary outcome in the real-world setting. This study assessed the association between NOACs (dabigatran, rivaroxaban, and apixaban) and warfarin and the risk of liver injury, as defined by laboratory tests. METHODS: Patients newly diagnosed with AF and prescribed NOACs or warfarin between 2010 and 2016, identified using the Hong Kong Clinical Database and Reporting System, were matched on age, sex, health status scores, comorbidities, and medications by propensity score on a 1:1 ratio. Risk of liver injury, defined as laboratory test values >3 times the upper limit of normal of alanine aminotransferase or aspartate aminotransferase and >2 times the upper limit of normal of total bilirubin, was compared between NOAC and warfarin users using Cox proportional hazards regression. RESULTS: After propensity score matching, 13,698 patients were included, of which 141 (2.1%) NOAC users and 232 (3.4%) warfarin users developed liver injury. The hazard ratio (HR) for NOAC vs warfarin users was 0.71 (95% confidence interval: 0.58-0.89). When comparing individual NOACs, only dabigatran (hazard ratio: 0.63; 95% confidence interval: 0.48-0.82) was associated with a lower risk of liver injury. DISCUSSION: Among patients with AF, NOACs as a group, and dabigatran alone were associated with a significantly lower risk of laboratory-based liver injury when compared with warfarin. However, liver injury occurs more frequently in real-world practice than in NOAC randomized controlled trials.
INTRODUCTION: The risk of liver injury in patients with atrial fibrillation (AF) using nonvitamin K antagonist oral anticoagulants (NOACs) has not been previously examined using liver function tests as the primary outcome in the real-world setting. This study assessed the association between NOACs (dabigatran, rivaroxaban, and apixaban) and warfarin and the risk of liver injury, as defined by laboratory tests. METHODS:Patients newly diagnosed with AF and prescribed NOACs or warfarin between 2010 and 2016, identified using the Hong Kong Clinical Database and Reporting System, were matched on age, sex, health status scores, comorbidities, and medications by propensity score on a 1:1 ratio. Risk of liver injury, defined as laboratory test values >3 times the upper limit of normal of alanine aminotransferase or aspartate aminotransferase and >2 times the upper limit of normal of total bilirubin, was compared between NOAC and warfarin users using Cox proportional hazards regression. RESULTS: After propensity score matching, 13,698 patients were included, of which 141 (2.1%) NOAC users and 232 (3.4%) warfarin users developed liver injury. The hazard ratio (HR) for NOAC vs warfarin users was 0.71 (95% confidence interval: 0.58-0.89). When comparing individual NOACs, only dabigatran (hazard ratio: 0.63; 95% confidence interval: 0.48-0.82) was associated with a lower risk of liver injury. DISCUSSION: Among patients with AF, NOACs as a group, and dabigatran alone were associated with a significantly lower risk of laboratory-based liver injury when compared with warfarin. However, liver injury occurs more frequently in real-world practice than in NOAC randomized controlled trials.
Authors: Joseph William Clinton; Sara Kiparizoska; Soorya Aggarwal; Stephanie Woo; William Davis; James H Lewis Journal: Drug Saf Date: 2021-09-17 Impact factor: 5.606
Authors: Carlos King Ho Wong; Lung Yi Mak; Ivan Chi Ho Au; Francisco Tsz Tsun Lai; Xue Li; Eric Yuk Fai Wan; Celine Sze Ling Chui; Esther Wai Yin Chan; Wing Yiu Cheng; Franco Wing Tak Cheng; Man Fung Yuen; Ian Chi Kei Wong Journal: J Hepatol Date: 2022-07-09 Impact factor: 30.083