Anticoagulation safely reduces stroke risk in cirrhotics with AF
Anticoagulation treatment in patients with atrial fibrillation and cirrhosis reduces the risk of stroke without increasing the likelihood of bleeding, according to a recent meta-analysis.
Researchers reviewed databases of Embase, Medline and Cochrane for studies focused on cirrhotic patients taking oral anticoagulants for AF. Only those that reported stroke and bleeding outcomes were eligible for inclusion.
A total of seven cohort studies were eventually included in the meta-analysis, yielding a cumulative sample size of 19,798 patients. Participants were followed up for a mean of 11 years, during which time the use of anticoagulation ranged from 8.3–53.9 percent.
Pooled analysis revealed that anticoagulation significantly reduced the risk of stroke in participants (hazard ratio [HR], 0.58; 95 percent CI, 0.35–0.96). On the other hand, there was no associated significant increase in the risk of bleeding (HR, 1.45; 0.96–2.17).
Notably, when compared with warfarin, researchers found that the use of direct oral anticoagulants was associated with a significantly lower risk of bleeding among cirrhotic patients with AF (odds ratio, 1.93; 1.001–3.70).
In terms of study quality, funnel plots and Egger’s regression asymmetry analysis revealed no significant publication bias, though there was some variation in how cirrhosis was defined. While some referred to health database systems, other studies employed clinical diagnoses, lab tests, imaging techniques and markers.
“Our study suggests that anticoagulation treatment in cirrhotic patients with AF may be beneficial. Hence, rather than refraining cirrhotic patients from systemic anticoagulation due to bleeding diathesis concerns, patients should be prescribed this type of therapy with close clinical and laboratory surveillance,” said researchers.