Efficacy and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Liver Disease: a Meta-Analysi
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ORIGINAL ARTICLE
Efficacy and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Liver Disease: a Meta-Analysis and Systematic Review Zhi-Chun Huang 1 & Chang-Qing Li 1 & Xiao-Yu Liu 1 & Zhong-Chao Cao 1 & Hai-Yu Jia 1 & Ying Dong 2 & Tian-Long Liu 2 & Jian-jun Sun 2 Accepted: 27 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Liver disease is associated with increased bleeding risk. The efficacy and safety of direct oral anticoagulants (DOACs) is a subject of contention in atrial fibrillation (AF) patients with liver disease. Methods Electronic databases (PubMed, Embase, and Cochrane Library) were searched to retrieve studies on the efficacy and safety of DOACs versus warfarin in AF patients with liver disease from January 1980 to April 2020. A meta-analysis was conducted using a random-effects model. Results Six studies involving 41,859 patients were included. Compared with warfarin, DOACs demonstrated significant reduction in ischemic stroke (HR, 0.68; 95% CI (0.54–0.86)), major bleeding (0.74 (0.59–0.92)), and intracranial hemorrhage (ICH) (0.48 (0.40–0.58)), with no significant effect on gastrointestinal bleeding (P = 0.893) in AF patients with liver disease. Similar results were observed in regular-dose, reduced-dose, and active liver disease subgroups, albeit Asian patients had a slight reduction in major bleeding (P = 0.055). Furthermore, the pooled estimates of individual DOAC subgroups indicated that dabigatran and apixaban led to greater safety in major bleeding (P < 0.001), ICH (P < 0.001), and gastrointestinal bleeding (P < 0.005) in these patients. The same trends were observed in AF patients with cirrhosis. Conclusions Our findings suggest that DOACs significantly reduce the risk of ischemic stroke, major bleeding, and ICH, with no significant effect on the risk of gastrointestinal bleeding in AF patients with liver disease compared with warfarin. Keywords Anticoagulants . Atrial fibrillation . Liver failure . Liver cirrhosis . Meta-analysis
Introduction Atrial fibrillation (AF) is the most common clinical arrhythmia and increases the mortality and stroke risk by 1.5- and 2.5fold, respectively [1, 2]. Treatment with long-term oral
anticoagulants (OAC) is recommended in AF patients with a high risk of thrombosis in order to reduce the risk of ischemic events [3, 4]. Impaired liver function and cirrhotic liver disease have been shown to be the most important risk factors for bleeding in AF patients receiving anticoagulant therapy [5, 6].
* Jian-jun Sun [email protected]
Hai-Yu Jia [email protected]
Zhi-Chun Huang [email protected]
Ying Dong [email protected]
Chang-Qing Li [email protected]
Tian-Long Liu [email protected]
Xiao-Yu Liu [email protected] Zhong-Chao Cao [email protected]
1
Department of Cardiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
2
Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, 1 Tong Dao North Street, Ho
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