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American Journal of Cardiovascular Drugs

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01-04-2020 | Dabigatran | Systematic Review

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

Authors: Yonghui Fu, Wengen Zhu, Yue Zhou, He Chen, Lan Yan, Wenfeng He

Published in: American Journal of Cardiovascular Drugs | Issue 2/2020

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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Title: Non-vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Liver Disease: A Meta-Analysis and Systematic Review
Authors: Yonghui Fu
Wengen Zhu
Yue Zhou
He Chen
Lan Yan
Wenfeng He
Publication date: 01-04-2020
Publisher: Springer International Publishing
Keywords: Dabigatran
Edoxaban
Gastrointestinal Bleeding
Oral Anticoagulant
Atrial Fibrillation
Warfarin
Rivaroxaban
Published in: American Journal of Cardiovascular Drugs / Issue 2/2020
Print ISSN: 1175-3277
Electronic ISSN: 1179-187X
DOI: https://doi.org/10.1007/s40256-019-00369-x

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Results

Conclusions

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