Anticoagulation in atrial fibrillation and liver disease: a pooled-analysis of > 20000 patients
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Anticoagulation in atrial fibrillation and liver disease: a pooled-analysis of > 20000 patients. / Chen, Shaojie; Pürerfellner, Helmut; Meyer, Christian; Sommer, Philipp; Galindo Kiuchi, Márcio; Martinek, Martin; Futyma, Piotr; Zanchi, Simone; Zhu, Lin; Schratter, Alexandra; Wang, Jiazhi; Acou, Willem-Jan; Liu, Shaowen; Ling, Zhiyu; Yin, Yuehui; Ouyang, Feifan; Chun, Julian K R; Schmidt, Boris.
In: EUR HEART J-CARD PHA, Vol. 8, No. 4, 08.06.2022, p. 336-345.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Anticoagulation in atrial fibrillation and liver disease: a pooled-analysis of > 20000 patients
AU - Chen, Shaojie
AU - Pürerfellner, Helmut
AU - Meyer, Christian
AU - Sommer, Philipp
AU - Galindo Kiuchi, Márcio
AU - Martinek, Martin
AU - Futyma, Piotr
AU - Zanchi, Simone
AU - Zhu, Lin
AU - Schratter, Alexandra
AU - Wang, Jiazhi
AU - Acou, Willem-Jan
AU - Liu, Shaowen
AU - Ling, Zhiyu
AU - Yin, Yuehui
AU - Ouyang, Feifan
AU - Chun, Julian K R
AU - Schmidt, Boris
N1 - © Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2021. For permissions, please email: journals.permissions@oup.com.
PY - 2022/6/8
Y1 - 2022/6/8
N2 - AIMS: Anticoagulation for atrial fibrillation 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 ischaemic 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 analysed (subset A: N = 10 275, 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 [odds ratio (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 favourable 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.
AB - AIMS: Anticoagulation for atrial fibrillation 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 ischaemic 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 analysed (subset A: N = 10 275, 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 [odds ratio (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 favourable 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.
U2 - 10.1093/ehjcvp/pvab032
DO - 10.1093/ehjcvp/pvab032
M3 - SCORING: Journal article
C2 - 33871577
VL - 8
SP - 336
EP - 345
JO - EUR HEART J-CARD PHA
JF - EUR HEART J-CARD PHA
SN - 2055-6837
IS - 4
ER -
