Background

Patients with atrial fibrillation (AF) have a higher risk of developing thromboembolic events. Current guidelines recommend the use of oral anticoagulants for stroke prevention in these patients. Several clinical trials demonstrated that direct oral anticoagulants (DOACs) have similar efficacy and are safer alternatives to traditional oral anticoagulants. However, patients with concomitant liver cirrhosis were excluded from these trials.

Objective

We aimed to systematically identify and review published clinical studies on the use of DOACs in patients with AF and liver cirrhosis and assess the efficacy and safety of DOACs in these patients.

Methods

A systematic review of clinical trials and retrospective studies was conducted by searching the PubMed, Cochrane Library, Embase, SCOPUS, and Web of Science databases up to September 2020.

Results

Three retrospective studies were included, involving 4011 patients with AF and liver cirrhosis. The use of DOACs was associated with a significant reduction in ischemic stroke (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.42–0.90; p = 0.01), major bleeding events (HR 0.64; 95% CI 0.57–0.72; p < 0.001), and intracranial hemorrhage (HR 0.49; 95% CI 0.40–0.59; p < 0.001).

Conclusions

Compared with warfarin in patients with AF and liver cirrhosis, DOACs appear to be associated with improved efficacy and safety outcomes. Randomized controlled trials are warranted to confirm these findings.

中文翻译：

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直接口服抗凝剂和维生素 K 拮抗剂在心房颤动合并肝硬化患者中的疗效和安全性比较：系统评价和荟萃分析

背景

心房颤动 (AF) 患者发生血栓栓塞事件的风险更高。目前的指南建议在这些患者中使用口服抗凝剂预防卒中。多项临床试验表明，直接口服抗凝剂 (DOAC) 具有相似的疗效，并且是传统口服抗凝剂的更安全替代品。然而，合并肝硬化的患者被排除在这些试验之外。

客观的

我们旨在系统地识别和回顾已发表的关于在 AF 和肝硬化患者中使用 DOAC 的临床研究，并评估 DOAC 在这些患者中的疗效和安全性。

方法

通过搜索 PubMed、Cochrane 图书馆、Embase、SCOPUS 和 Web of Science 数据库，对截至 2020 年 9 月的临床试验和回顾性研究进行了系统评价。

结果

纳入三项回顾性研究，涉及 4011 名 AF 和肝硬化患者。DOAC 的使用与缺血性卒中（风险比 [HR] 0.62；95% 置信区间 [CI] 0.42–0.90；p = 0.01）、大出血事件（HR 0.64；95% CI 0.57–0.72）显着减少相关; p < 0.001) 和颅内出血 (HR 0.49; 95% CI 0.40–0.59; p < 0.001)。

结论

在 AF 和肝硬化患者中，与华法林相比，DOAC 似乎与改善疗效和安全性结局相关。有必要进行随机对照试验来证实这些发现。