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Non-vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Liver Disease: A Meta-Analysis and Systematic Review

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A Letter to the Editor to this article was published on 11 August 2020

A Letter to the Editor to this article was published on 11 August 2020

Abstract

Background

The effect of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) and liver disease remains largely unresolved. Therefore, we performed a meta-analysis to compare the efficacy and safety of NOACs with warfarin in this population.

Methods

We systematically searched the Cochrane Library, PubMed, and Embase databases for studies reporting the comparisons of NOACs with warfarin in patients with AF and liver disease. A random-effects model was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs).

Results

A total of six studies with 41,954 participants were included in this meta-analysis. In AF patients with liver disease, compared with warfarin use, the use of NOACs was associated with reduced risks of all-cause death (RR 0.78, 95% CI 0.66–0.93), major bleeding (RR 0.68, 95% CI 0.53–0.88), and intracranial hemorrhage (RR 0.49, 95% CI 0.41–0.59), but had comparable risks of stroke or system embolism (RR 0.80, 95% CI 0.57–1.12) and gastrointestinal bleeding (RR 0.90, 95% CI 0.61–1.34). In AF patients with cirrhosis, NOACs significantly reduced the risks of major bleeding (RR 0.53, 95% CI 0.37–0.76), gastrointestinal bleeding (RR 0.57, 95% CI 0.38–0.84), and intracranial hemorrhage (RR 0.55, 95% CI 0.31–0.97) compared with warfarin.

Conclusions

Based on current publications, the use of NOACs is at least non-inferior to warfarin in patients with AF and liver disease.

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Authors and Affiliations

  1. Department of Psychiatry, Jiangxi Mental Hospital, Nanchang, 330029, Jiangxi, China

    Yonghui Fu & Lan Yan

  2. Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China

    Wengen Zhu

  3. Department of Children’s Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China

    Yue Zhou

  4. Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China

    He Chen & Wenfeng He

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  1. Yonghui Fu
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Correspondence to Wenfeng He.

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No external funding was used in the preparation of this review.

Conflict of interest

Yonghui Fu, Wengen Zhu, Yue Zhou, He Chen, Lan Yan, and Wenfeng He declare that they have no potential conflicts of interest that might be relevant to the contents of this review.

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Fu, Y., Zhu, W., Zhou, Y. et al. Non-vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Liver Disease: A Meta-Analysis and Systematic Review. Am J Cardiovasc Drugs 20, 139–147 (2020). https://doi.org/10.1007/s40256-019-00369-x

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