Efficacy and Safety of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients With Impaired Liver Function: A Retrospective Cohort Study

Abstract

BackgroundPatients with impaired liver function (ILF) were excluded from clinical trials that investigated non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation. The aim of this study was to evaluate the efficacy and safety of NOACs in atrial fibrillation patients with ILF.Methods and ResultsA cohort study based on electronic medical records was conducted from 2009 to 2016 at a multicenter healthcare provider in Taiwan and included 6451 anticoagulated atrial fibrillation patients (aged 76.7±7.0 years, 52.5% male). Patients were classified into 2 subgroups: patients with normal liver function (n=5818) and patients with ILF (n=633, 9.8%). Cox regression analysis was performed to investigate the risks of thromboembolism, bleeding, and death associated with use of NOACs and warfarin in patients with normal liver function and ILF, respectively. In patients with normal liver function, compared with warfarin therapy (n=2928), NOAC therapy (n=4048) was associated with significantly lower risks of stroke or systemic embolism (adjusted hazard ratio: 0.75; 95% confidence interval, 0.65–0.88; P<0.001) and death (adjusted hazard ratio: 0.69; 95% confidence interval, 0.60–0.80; P<0.001) with no difference in major bleeding or gastrointestinal bleeding. In patients with ILF, compared with warfarin therapy (n=394), NOAC therapy (n=342) was associated with significantly lower risk of death (adjusted hazard ratio: 0.64; 95% confidence interval, 0.49–0.83; P<0.001), but no difference in stroke or systemic embolism, major bleeding, or gastrointestinal bleeding.ConclusionsIn atrial fibrillation patients with ILF, NOAC therapy and warfarin therapy were associated with similar risks of stroke or systemic embolism, major bleeding, and gastrointestinal bleeding.

Glycemic status and risks of thromboembolism and major bleeding in patients with atrial fibrillation

“…All patients' data until 2019 were collected from the Chang Gung Memorial Hospital (CGMH) Medical System, which is the largest healthcare provider in Taiwan. The CGMH Medical System consists of four tertiary care medical centers and three major teaching hospitals, with total hospital beds of up to 10,000 and around 280,000 patients being admitted per year [16]. In 2015, there were approximately 500,000 emergency department visits and 8,600,000 outpatient department visits to the CGMH, accounting for 10% of the Taiwanese medical service annually [16,17].…”

“…The CGMH Medical System consists of four tertiary care medical centers and three major teaching hospitals, with total hospital beds of up to 10,000 and around 280,000 patients being admitted per year [16]. In 2015, there were approximately 500,000 emergency department visits and 8,600,000 outpatient department visits to the CGMH, accounting for 10% of the Taiwanese medical service annually [16,17]. The advantage of the CGMH medical database is that each patient's detailed chart record, diagnosis, imaging, and laboratory data are all available [18].…”

Sodium glucose cotransporter‐2 inhibitor was associated with an improvement in left ventricular systolic function in patients with type 2 diabetes mellitus with impaired left ventricular systolic function

“…In the present study, all patients' data were obtained from the Chang Gung Memorial Hospital (CGMH) Medical System, which comprised four tertiary care medical centres and three major teaching hospitals with a total of 10 050 beds and admits approximately 280 000 patients annually in Taiwan. 11 The advantage of the CGMH medical database is that each patient's detailed chart record, diagnosis, imaging, and laboratory data are all available. 12 The identification number and personal information of each patient are encrypted and de-identified using a consistent encrypting procedure; therefore, informed consent was waived for this study.…”

Direct Oral Anticoagulants in Patients with Liver Disease in the Era of Non-Alcoholic Fatty Liver Disease Global Epidemic: A Narrative Review

“…Several new studies have been published since the release of the latest guidelines [67] and previous reviews on the use of DOACs in patients with cirrhosis [5,[74][75][76]. Original studies evaluating the use of DOACs vs traditional anticoagulants in patients with CLD are reported in Table 1 [77][78][79][80][81][82][83][84][85][86][87][88][89].…”

“…Reduced doses of DOACs were prescribed from 50-60% [86] to 90% [89] of patients. In one study no data were provided about DOACs dosage [87]. The quality of anticoagulation control as reflected by time in therapeutic range (TTR) in the warfarin group was not evaluated.…”