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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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Atrial fibrillation, liver disease, antithrombotics and risk of cerebrovascular events: A population-based cohort

Hui-Chin Lai1, Wu-Chien Chien2, Chi-Hsiang Chung3

  • 1Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei.

International Journal of Cardiology
|September 1, 2016
PubMed

Insights

Patients with atrial fibrillation (AF) and liver disease face a higher risk of cerebrovascular events. Antithrombotic therapies did not demonstrate a significant preventive effect in this population.

Area of Science:

  • Cardiology
  • Hepatology
  • Neurology

Background:

  • Atrial fibrillation (AF) patients with liver disease are under-investigated for cerebrovascular event (CVE) risk.
  • The efficacy of antithrombotic therapy in this population is unclear.

Purpose of the Study:

  • To investigate the risk of CVEs in AF patients with and without liver disease.
  • To evaluate the effectiveness of antithrombotic therapy in preventing CVEs in AF patients with liver disease.

Main Methods:

  • Retrospective cohort study of 18+ year old AF patients (2005-2009) from Taiwan's National Health Insurance Database.
  • Patients categorized into Liver (N=433) and Non-liver (N=3490) cohorts based on advanced liver disease diagnosis.
  • Follow-up to determine CVE incidence, antithrombotic effects, and risk factors using Cox regression.

Main Results:

  • Liver cohort showed significantly higher incidence of ischemic stroke (aHR 1.502) and overall CVEs (aHR 1.535) compared to the Non-liver cohort.
  • Risk factors for CVEs in the Liver cohort included aging (≥65), diabetes mellitus (DM), and CHA2DS-VASc score ≥2.
  • Neither antiplatelet agents nor vitamin-K antagonists showed a significant correlation with reduced CVEs.

Conclusions:

  • AF patients with advanced liver disease have an increased vulnerability to cerebrovascular events, particularly those with older age, DM, or high CHA2DS-VASc scores.
  • Current antithrombotic therapies did not alter the propensity for cerebrovascular events in this high-risk group.
Abstract

Keywords:
AntithromboticAtrial fibrillationCHA2DS2-VAScCerebrovascularLiverStroke

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