Anticoagulation Safety in Patients with Cirrhosis and AF
CLINICAL QUESTION: Do patients with cirrhosis and AF who are treated with anticoagulation have increased adverse safety events compared with patients with cirrhosis and AF who are not treated with anticoagulation?
BACKGROUND: Randomized controlled trials have demonstrated that anticoagulation decreases the risk of ischemic stroke in patients with AF and risk factors for stroke. However, little is known about the safety of anticoagulation in patients with cirrhosis and AF, as all trials to date have excluded this population.
STUDY DESIGN: Retrospective cohort study SETTING: University of California, Los Angeles Health System, a large academic public healthcare system
SYNOPSIS: Using the UCLA Data Discovery Repository of all patients interacting with the UCLA Health System, the authors identified 1,063 adults with cirrhosis and concurrently or subsequently diagnosed AF. Patients were grouped based on whether they had an outpatient prescription for anticoagulants or not; they were followed for targeted safety outcomes and compared across different classes of anticoagulants. Patients on anticoagulation had increased binary risk of hospitalization (odds ratio [OR], 1.54; P = 0.010), hospitalization count (OR , 1.74; P <0.001), and risk of intensive care unit admission (OR, 1.41; P <0.047) compared with propensity-matched non-anticoagulated patients. However, anticoagulation was not associated with increased mortality, blood product transfusion, or hospital length of stay. Direct oral anticoagulants were associated with increased binary risk of hospitalization compared with warfarin (OR, 4.70; P <0.001) and with no anticoagulation (OR, 1.52; P <0.038). This study presents new information on anticoagulation safety in this population; however, results may not be generalizable outside of a large academic center with high volumes of complex patients with cirrhosis.
BOTTOM LINE: Anticoagulation in patients with cirrhosis who develop AF is associated with an increased rate of hospitalization and intensive care unit admission, but not with increased mortality or transfusion requirement.
CITATION: Song JJ, et al. Assessing safety of anticoagulation for atrial fibrillation in patients with cirrhosis: a real-world outcomes study. J Cardiovasc Pharmacol Ther. 2024;29:10742484241256271. doi: 10.1177/10742484241256271
Dr. Marcantonio
Dr. Marcantonio is a medicine-pediatrics hospitalist at Duke Regional Hospital and Duke University Hospital and an assistant professor of medicine and of pediatrics at Duke University, all in Durham, N.C.