Assessment of the efficiency and safety of anticoagulation therapy in patients with liver cirrhosis and atrial fibrillation

Abstract

Aim of the study Currently, there are insufficient scientific data regarding the efficacy and safety of direct oral anticoagulants (DOACs) compared to warfarin in patients with both liver cirrhosis (LC) and atrial fibrillation (AF). The aim of the study was to analyze the frequency and risk factors for the development of thrombotic and hemorrhagic complications in patients with LC and AF after DOAC treatment compared to warfarin. Material and methods A randomized clinical trial was conducted including 56 patients with both LC and AF treated with dabigatran ( n = 30) and warfarin ( n = 26). The frequency and risk factors of hemorrhagic and thrombotic complications were evaluated after 3 months of observation. Results and Discussion The overall frequency of bleeding was significantly higher after treatment with warfarin ( p = 0.038). The frequency of major and minor bleeding events did not differ statistically significantly between the two groups ( p > 0.05). Factors which significantly increased the risk of bleeding were: glomerular filtration rate (GFR) < 60 ml/min/1.73 m 2 (adjusted hazard ratio (AHR) = 0.82, CI: 0.69-0.96, p = 0.02), constant of thrombin activity (CTA) < 25 units of low-frequency piezoelectric thromboelastography (AHR = 0.66, CI: 0.46-0.92, p = 0.017) and prior history of bleeding (AHR = 108, CI: 8.78-134, p < 0.001). Conclusions The use of dabigatran in patients with Child-Pugh class A and B of LC and AF has advantages over warfarin, as it is clinically associated with a lower incidence of bleeding. An increased risk of bleeding is observed in patients with LC classes A and B according to the Child-Pugh scale and AF, who have a reduced GFR < 60 ml/min/1.73 m 2 , CTA < 25 units and a prior history of bleeding.

Effectiveness of Direct Oral Anticoagulants and Vitamin K Antagonists in Preventing Stroke in Patients With Atrial Fibrillation and Liver Cirrhosis: A Systematic Review and Meta-Analysis

“…There was no evidence of significant heterogeneity (I-square: 0%). References [12][13][14][15][16][17][18][19]21].…”

“…Despite this, DOACs have gained traction and are now recommended in the BAVENO guideline for patients with Child-Turcotte-Pugh (CTP) A and B cirrhosis [11]. Different studies have compared DOACs in patients with liver cirrhosis [12][13][14][15][16][17][18][19][20][21]. However, much of the evidence supporting the use of DOACs in atrial fibrillation patients with liver cirrhosis has primarily come from studies with small sample sizes [12,13,15,17,18].…”

“…Different studies have compared DOACs in patients with liver cirrhosis [12][13][14][15][16][17][18][19][20][21]. However, much of the evidence supporting the use of DOACs in atrial fibrillation patients with liver cirrhosis has primarily come from studies with small sample sizes [12,13,15,17,18]. A previous systematic review endorsed the use of DOACs in patients with atrial fibrillation and liver cirrhosis, but several new studies have emerged since [12][13][14]20].…”

“…However, much of the evidence supporting the use of DOACs in atrial fibrillation patients with liver cirrhosis has primarily come from studies with small sample sizes [12,13,15,17,18]. A previous systematic review endorsed the use of DOACs in patients with atrial fibrillation and liver cirrhosis, but several new studies have emerged since [12][13][14]20]. Thus, this study was needed to compare the effectiveness and safety of DOACs to prevent stroke with VKAs in these patients.…”

Direct oral anticoagulants in cirrhosis: Rationale and current evidence

“…Additionally, a recent small RCT of moderate quality involving 56 patients with CTP-A and CTP-B cirrhosis and atrial fibrillation has shown a significantly lower overall frequency of bleeding events with dabigatran compared to VKA. 106 The choice of anticoagulation in patients with CTP-C cirrhosis remains an open question because only limited data are available on the subject. Small-scale observational studies of fewer than 20 patients with CTP-C cirrhosis found no statistical difference in efficacy and safety between DOAC and traditional anticoagulants for treating VTE and preventing systemic embolism in case of atrial fibrillation.…”