Anticoagulation in atrial fibrillation and liver disease: a pooled-analysis of > 20 000 patients

作者全名："Chen, Shaojie; Purerfellner, Helmut; Meyer, Christian; Sommer, Philipp; Kiuchi, Marcio Galindo; Martinek, Martin; Futyma, Piotr; Zanchi, Simone; Zhu, Lin; Schratter, Alexandra; Wang, Jiazhi; Acou, Willem-Jan; Liu, Shaowen; Ling, Zhiyu; Yin, Yuehui; Ouyang, Feifan; Chun, Julian K. R.; Schmidt, Boris"

作者地址："[Chen, Shaojie; Chun, Julian K. R.; Schmidt, Boris] Goethe Univ Frankfurt Am Main, Cardioangiol Ctr Bethanien CCB, Kardiol, Med Klin 3,Agaples Markus Krankenhaus,Akad Lehrkr, Wilhelm Epstein Str 4, D-60431 Frankfurt, Germany; [Chen, Shaojie; Chun, Julian K. R.] Univ Lubeck, Die Sekt Med, Lubeck, Germany; [Purerfellner, Helmut; Martinek, Martin] Ordensklinikum Linz Elisabethinen, Dept Kardiol & Elektrophysiol, Akad Lehrkrankenhaus, Linz, Austria; [Meyer, Christian] Univ Hosp Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, cNEP,Cardiac Neuro & Electrophysiol Res Grp, Hamburg, Germany; [Meyer, Christian] DZHK German Ctr Cardiovasc Res, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany; [Meyer, Christian] Evangel Hosp Dusseldorf, Dept Cardiol, Dusseldorf, Germany; [Meyer, Christian] Heinrich Heine Univ Hosp Dusseldorf, Dusseldorf, Germany; [Sommer, Philipp] Univ Klin Ruhr Univ Bochum, Herz & Diabeteszentrum Nordrhein Westfalen, Klin Elektrophysiol Rhythmol, Bad Oeynhausen, Germany; [Kiuchi, Marcio Galindo] Univ Western Australia, Sch Med, Royal Perth Hosp Unit, Perth, WA, Australia; [Futyma, Piotr] St Josephs Heart Rhythm Ctr, Rzeszow, Poland; [Zanchi, Simone] Poliambulanza Inst Hosp Fdn, Div Cardiol, Brescia, Italy; [Zhu, Lin] Goethe Univ Frankfurt am Main, Med Geriatr Klin, Agaples Markus Krankenhaus, Akad Lehrkrankenhaus, Frankfurt, Germany; [Schratter, Alexandra] Krankenhaus Hietzing Wien, Med Abt Kardiol, Vienna, Austria; [Wang, Jiazhi] Charite Univ Med Berlin, Intensivmed, Berlin, Germany; [Acou, Willem-Jan] AZ Delta, Dept Cardiol, Roeselare, Belgium; [Liu, Shaowen] Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Dept Cardiol, Sch Med, Shanghai, Peoples R China; [Ling, Zhiyu; Yin, Yuehui] Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 2, Chongqing, Peoples R China; [Ouyang, Feifan] Univ Klinikum Hamburg Eppendorf UKE, Univ Herz & Gefasszentrum, Klin & Poliklin Kardiol, Hamburg, Germany"

通信作者："Chen, SJ (通讯作者)，Goethe Univ Frankfurt Am Main, Cardioangiol Ctr Bethanien CCB, Kardiol, Med Klin 3,Agaples Markus Krankenhaus,Akad Lehrkr, Wilhelm Epstein Str 4, D-60431 Frankfurt, Germany.; Chen, SJ (通讯作者)，Univ Lubeck, Die Sekt Med, Lubeck, Germany."

来源：EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000755822000001

JCR分区：Q1

影响因子：7.1

年份：2022

卷号：8

期号：4

开始页：336

结束页：345

文献类型：Article

关键词：Anticoagulation; Atrial fibrillation; Stroke; Liver disease; Liver dysfunction

摘要："Aims Anticoagulation for atrial fibrillation patients with liver disease represents a clinical dilemma. We sought to evaluate the efficacy/safety of different anticoagulation, i.e. vitamin K antagonist (VKA) and non-VKA oral anticoagulants (NOACs) in such patient group. Methods and results This was a pooled-analysis enrolling up-to-date clinical data. Two subsets: subset A (VKA vs. Non-Anticoagulation) and subset B (NOACs vs. VKA) were pre-specified. The study outcomes were ischaemic stroke (IS)/thromboembolism (TE), major bleeding (MB), intracranial bleeding (ICB), gastrointestinal bleeding (GIB), and all-cause mortality. A total of 20 042 patients' data were analysed (subset A: N = 10 275, subset B: N = 9767). Overall mean age: 71 +/- 11 years, mean CHA(2)DS(2)-VASc score: 4.0 +/- 1.8, mean HAS-BLED score: 3.6 +/- 1.2. The majority of the patients had Child-Pugh category (A-B). As compared with Non-Anticoagulation, VKA seemed to reduce the risk of IS/TE [odds ratio (OR): 0.60, P = 0.05], but heighten the risk of all-bleeding events including MB (OR: 2.81, P = 0.01), ICB (OR: 1.60, P = 0.01), and GIB (OR: 3.32, P = 0.01). When compared with VKA, NOACs had similar efficacy in reducing the risk of IS/TE (OR: 0.82, P = 0.64), significantly lower risk of MB (OR: 0.54, P = 0.0003) and ICB (OR: 0.35, P < 0.0001), and trend towards reduced risk of GIB (OR: 0.72, P = 0.12) and all-cause mortality (OR: 0.79, P = 0.35). The favourable effects were maintained in subgroups of individual NOAC. Conclusions VKA appears to reduce the risk of IS/TE but increase all-bleeding events. NOACs have similar effect in reducing the risk of IS/TE and have significantly lower risk of MB and ICB as compared with VKA. NOACs seem to be associated with better clinical outcome than VKA in patients with mild-moderate liver disease."

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