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Anticoagulation in patients with atrial fibrillation and liver cirrhosis

Eleni Karapedi1, Nikolaos Papadopoulos1, Eleni-Myrto Trifylli1

  • 11Department of Internal Medicine, 417 Army Share Fund Hospital (Eleni Karapedi, Nikolaos Papadopoulos, Eleni-Myrto Trifylli, Evangelos Koustas, Georgios Aloizos).

Annals of Gastroenterology
|November 21, 2022
PubMed

Insights

Atrial fibrillation (AF) in liver cirrhosis patients presents a complex treatment challenge due to bleeding and clotting risks. This review examines direct-acting oral anticoagulants (DOACs) and traditional agents for AF management in cirrhosis.

Area of Science:

  • Hepatology
  • Cardiology
  • Pharmacology

Background:

  • Atrial fibrillation (AF) is a growing comorbidity in liver cirrhosis patients, impacting prognosis.
  • Liver cirrhosis elevates risks of both thrombosis and bleeding, complicating anticoagulation decisions.
  • Nonalcoholic fatty liver disease and alcohol-associated liver disease are key contributors to AF in cirrhosis.

Purpose of the Study:

  • To review the current literature on anticoagulation therapies for liver cirrhosis patients with AF.
  • To investigate the efficacy and safety of direct-acting oral anticoagulants (DOACs) in this population.
  • To compare DOACs with traditional antithrombotic agents like vitamin K antagonists and heparins.

Main Methods:

  • Systematic literature search for studies on anticoagulation in liver cirrhosis and AF.
  • Analysis of published data on DOACs, vitamin K antagonists, and heparins.
  • Evaluation of efficacy and safety outcomes reported in the selected literature.

Main Results:

  • Limited clinical data exists on DOACs in liver cirrhosis patients with AF.
  • Traditional anticoagulants also present challenges in this high-risk group.
  • Further research is needed to establish optimal anticoagulation strategies.

Conclusions:

  • Anticoagulation in liver cirrhosis with AF remains challenging due to bleeding and thrombotic risks.
  • Evidence for DOACs in this specific patient group is scarce, necessitating cautious use.
  • More clinical trials are required to guide the safe and effective use of anticoagulants in cirrhotic patients with AF.

Keywords:
Atrial fibrillationdirect-acting oral anticoagulantsnonalcoholic fatty liver diseasevitamin K antagonists

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