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Comparisons of direct oral anticoagulants and warfarin in patients with atrial fibrillation and liver cirrhosis

Session Poster Session 5

Speaker Tze-Fan Chao

Event : ESC Congress 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Clinical
  • Session type : Poster Session

Authors : TF Chao (Taipei,TW), GYH Lip (Liverpool,GB), SA Chen (Taipei,TW)

T.F. Chao1 , G.Y.H. Lip2 , S.A. Chen1 , 1Taipei Veterans General Hospital - Taipei - Taiwan , 2University of Liverpool - Liverpool - United Kingdom ,

Atrial Fibrillation - Clinical

European Heart Journal ( 2019 ) 40 ( Supplement ), 2993

Background: Patients with atrial fibrillation (AF) and severe liver cirrhosis were excluded from the pivotal randomized trials comparing direct oral anticoagulants (DOACs) and warfarin. In the present study, we compared the effectiveness and safety of DOACs and warfarin among AF patients with liver cirrhosis.

Method: A total of 3,691 AF patients with liver cirrhosis having a CHA2DS2-VASc score ≥1 for males and ≥2 for females and received oral anticoagulants (DOACs in 2,548 and warfarin in 1,143) were identified from the Taiwan National Health Insurance Research Database. The effectiveness and safety were compared between DOACs and warfarin groups.

Results: There was a trend suggesting a lower risk of ischemic stroke with DOACs compared to warfarin (2.91%/yr vs 3.41%/yr; HR 0.743, p=0.060). The risks of bleeding events were lower with DOACs compared to warfarin with a HR (95% CI) of 0.718 (0.573–0.899, p=0.004) for major bleeding and 0.509 (0.292–0.889, p=0.018) for ICH. The risk of mortality was also lower in patients treated with DOACs (HR=0.483; 95% CI: 0.424–0.551, p<0.001). The cumulative incidence curves of each events for 2 groups are shown in Figure. The results were essentially similar after the propensity matching analysis of 2 groups.

Conclusion: Compared to warfarin, DOACs were associated with a lower risk of ICH, major bleeding and mortality among AF patient with liver cirrhosis.

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