Related Experiment Video

Updated: Oct 9, 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

Risks Versus Benefits of Anticoagulation for Atrial Fibrillation in Cirrhotic Patients

Jonggi Choi1, Junhwan Kim, Ju Hyun Shim

  • 1*Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;†Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and‡Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Journal of Cardiovascular Pharmacology
|October 10, 2017
PubMed

Insights

Warfarin use in cirrhotic patients with atrial fibrillation (AF) did not significantly lower stroke risk but increased major bleeding events. This suggests caution when prescribing anticoagulation for this patient group.

Area of Science:

  • Cardiology
  • Hepatology
  • Pharmacology

Background:

  • Cirrhotic patients with atrial fibrillation (AF) present a complex clinical challenge regarding anticoagulation.
  • Warfarin is a commonly used anticoagulant, but its safety and efficacy in liver cirrhosis are not well-established.

Purpose of the Study:

  • To investigate the clinical benefits and risks of warfarin anticoagulation in cirrhotic patients diagnosed with nonvalvular AF.
  • To compare the incidence of ischemic stroke and major bleeding events between warfarin users and nonusers.
  • To identify factors predicting ischemic stroke or major bleeding events in this population.

Main Methods:

  • Retrospective analysis of 465 cirrhotic patients with nonvalvular AF.
  • Comparison of ischemic stroke and major bleeding event rates between warfarin users and nonusers.
  • Multivariate analysis to identify independent predictors of stroke and bleeding.

Main Results:

  • Warfarin was used by 24.3% of patients, who had lower Child-Pugh scores and higher CHA2DS2VASc scores.
  • Ischemic stroke incidence was low and comparable between warfarin users (0.9%/year) and nonusers (1.2%/year), not significantly dependent on CHA2DS2VASc score.
  • Major bleeding events were significantly higher in warfarin users (5.9%) compared to nonusers (2.6%). Warfarin use and Child-Pugh score independently predicted bleeding events.

Conclusions:

  • Warfarin anticoagulation in cirrhotic patients with AF may not offer significant protection against ischemic stroke.
  • Warfarin use is associated with an increased risk of major bleeding complications in this patient cohort.
  • The findings suggest a need for careful consideration of risks versus benefits when using warfarin for anticoagulation in cirrhotic patients with AF.
Abstract

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

Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients05:31

Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

Published on: September 20, 2020

Related Concept Videos

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...
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...
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 binding...
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...
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,...
Hemodialysis I: Introduction01:25

Hemodialysis I: Introduction

Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...