Related Experiment Video

Updated: Feb 27, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

84.6K

Liver Cirrhosis in Patients With Atrial Fibrillation: Would Oral Anticoagulation Have a Net Clinical Benefit for

Ling Kuo1,2,3, Tze-Fan Chao4,2,3, Chia-Jen Liu5,6

  • 1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Journal of the American Heart Association
|June 25, 2017
PubMed

Insights

Warfarin use in atrial fibrillation patients with liver cirrhosis significantly lowers ischemic stroke risk and offers net clinical benefit compared to no treatment or antiplatelet therapy. Thromboprophylaxis is recommended for this population.

Area of Science:

  • Cardiology
  • Hepatology
  • Pharmacology

Background:

  • Patients with liver cirrhosis are often excluded from clinical trials on oral anticoagulation for stroke prevention in atrial fibrillation.
  • This exclusion raises questions about the net clinical benefit of anticoagulation in this specific patient group.

Purpose of the Study:

  • To investigate the net clinical benefit of oral anticoagulation therapy for stroke prevention in atrial fibrillation patients with liver cirrhosis.
  • To compare the risks of ischemic stroke and intracranial hemorrhage among different treatment strategies in this population.

Main Methods:

  • Utilized the National Health Insurance Research Database in Taiwan, analyzing 289,559 atrial fibrillation patients.
  • Focused on 10,336 patients with liver cirrhosis and a CHA2DS2-VASc score of 2 or higher, comparing no treatment, antiplatelet therapy, and warfarin.
  • Hazard ratios were calculated for ischemic stroke and intracranial hemorrhage.

Main Results:

  • Patients with liver cirrhosis had higher risks of ischemic stroke and intracranial hemorrhage compared to those without.
  • Warfarin use significantly lowered the risk of ischemic stroke (hazard ratio=0.76) in liver cirrhosis patients compared to no antithrombotic therapy.
  • No significant differences in intracranial hemorrhage risk were observed between untreated patients and those on antiplatelet therapy or warfarin.

Conclusions:

  • Warfarin use in atrial fibrillation patients with liver cirrhosis is associated with a reduced risk of ischemic stroke.
  • Warfarin therapy demonstrated a positive net clinical benefit compared to no treatment or antiplatelet therapy in this cohort.
  • Thromboprophylaxis, specifically warfarin, should be considered for stroke prevention in atrial fibrillation patients with liver cirrhosis.
Abstract

Keywords:
atrial fibrillationintracranial hemorrhageischemic strokeliver cirrhosis

More Related Videos

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation28:13

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

Published on: February 26, 2013

34.2K
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients05:31

Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

Published on: September 20, 2020

6.3K

Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.6K
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
2.1K
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
423
Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
685
Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
302
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
320