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Published on: February 28, 2012

Comparative outcomes of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and liver

Faizan Ahmed1, Saifullah Khan2, Najam Gohar3

  • 1Jersey Shore University Medical Center, Neptune, NJ, USA.

Journal of Thrombosis and Thrombolysis
|July 23, 2026
PubMed

Insights

Direct oral anticoagulants (DOACs) show reduced hepatic decompensation and mortality in atrial fibrillation (AF) patients with cirrhosis compared to warfarin. However, ischemic stroke risk remains similar, warranting further investigation into DOACs for this population.

Area of Science:

  • Cardiology
  • Hepatology
  • Pharmacology

Background:

  • Anticoagulation in atrial fibrillation (AF) patients with liver cirrhosis presents a complex balance between thrombosis and bleeding risks.
  • Direct oral anticoagulants (DOACs) are alternatives to warfarin, but their safety and efficacy in cirrhosis are not fully established.

Purpose of the Study:

  • To compare the safety and effectiveness of DOACs versus warfarin in patients with AF and liver cirrhosis.
  • To evaluate risks of hepatic decompensation, ischemic stroke, mortality, and bleeding events.

Main Methods:

  • Retrospective cohort study using the TriNetX Global Collaborative Network.
  • Included adult patients (≥18 years) with AF and cirrhosis on DOACs or warfarin.
  • Propensity score matching (1:1) was used to balance baseline characteristics, followed by 1-year outcome analysis.

Main Results:

  • DOAC use was associated with significantly lower risks of hepatic decompensation (HR 0.79) and all-cause mortality (HR 0.87) compared to warfarin.
  • No statistically significant differences were found in ischemic stroke, major bleeding, intracranial hemorrhage, gastrointestinal bleeding, or all-cause hospitalization.
  • The study included 2,522 matched pairs (5,044 patients) with 1-year follow-up.

Conclusions:

  • DOACs may offer a safer alternative to warfarin in AF patients with cirrhosis, reducing hepatic decompensation and mortality.
  • While DOACs did not show increased risks in major bleeding or stroke, their effectiveness in preventing ischemic stroke requires further study.
  • Findings are associative and hypothesis-generating due to the observational nature of the study.

Keywords:
Atrial fibrillationDirect oral anticoagulantsHepatic decompensationLiver cirrhosisStrokeWarfarin

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