Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Liver Cirrhosis.

IF 2.8 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of clinical gastroenterology Pub Date : 2024-11-01 DOI:10.1097/MCG.0000000000002089
Tien-Shin Chou, Yuan Lin, Ming-Lung Tsai, Chin-Ju Tseng, Jhih-Wei Dai, Ning-I Yang, Chih-Lang Lin, Li-Wei Chen, Ming-Jui Hung, Tien-Hsing Chen
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Abstract

Objective: Comparing direct oral anticoagulants (DOACs) and warfarin's efficacy and safety in patients with nonvalvular atrial fibrillation (AF) and liver cirrhosis (LC).

Background: Evidence of the pharmacodynamics of DOACs is limited in patients with AF and LC.

Methods: A retrospective cohort study was conducted in the largest hospital system in Taiwan, involving patients with AF and LC for the years 2012 to 2021. Hazards of thromboembolic events (ischemic stroke, transient ischemic attack, and systemic embolism), intracranial hemorrhage, gastrointestinal, major bleeding, and all-cause mortality were investigated with a new-user, active comparator design. Inverse probability of treatment weighting was applied to balance potential confounders between treatment groups.

Results: In total, 478 DOAC users and 247 warfarin users were included. DOACs and warfarin demonstrated similar trends in preventing thromboembolic events, namely ischemic stroke [adjusted hazard ratio (aHR), 1.05 (95% CI: 0.42-2.61)], transient ischemic attack [aHR, 1.36 (95% CI: 0.18-10.31)], and systemic embolism [aHR, 0.49 (95% CI: 0.14-1.70)]. DOAC use was associated with a similar risk of intracranial hemorrhage [aHR, 0.65 (95% CI: 0.26-1.59)] and gastrointestinal bleeding [aHR, 0.64 (95% CI: 0.39-1.03)], a decreased risk of major bleeding [aHR, 0.64 (95% CI: 0.42-0.99)], and a reduction in mortality [aHR, 0.73 (95% CI: 0.54-0.99)]. DOAC users exhibited a significant reduction in major bleeding risk in patients with Child-Pugh class A (aHR, 0.48; 95% CI: 0.33-0.70).

Conclusions: DOACs showed potential safety advantages over warfarin for patients with nonvalvular AF and LC, particularly in reducing major bleeding risk in those with Child-Pugh class A.

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直接口服抗凝剂与华法林在心房颤动和肝硬化患者中的疗效和安全性对比。
目的:比较直接口服抗凝药(DOACs)和华法林在非瓣膜性房颤(AF)和肝硬化(LC)患者中的疗效和安全性:比较直接口服抗凝药(DOACs)和华法林在非瓣膜性心房颤动(AF)和肝硬化(LC)患者中的疗效和安全性:有关 DOACs 在房颤和肝硬化患者中的药效学证据有限:在台湾最大的医院系统中开展了一项回顾性队列研究,涉及 2012 年至 2021 年的房颤和肝硬化患者。研究采用新用户、积极比较者设计,调查了血栓栓塞事件(缺血性中风、短暂性脑缺血发作和全身性栓塞)、颅内出血、胃肠道出血、大出血和全因死亡率的危险性。为了平衡治疗组之间的潜在混杂因素,采用了治疗反概率加权法:共纳入了 478 名 DOAC 用户和 247 名华法林用户。DOAC和华法林在预防血栓栓塞事件,即缺血性中风[调整后危险比(aHR),1.05(95% CI:0.42-2.61)]、短暂性脑缺血发作[aHR,1.36(95% CI:0.18-10.31)]和全身性栓塞[aHR,0.49(95% CI:0.14-1.70)]方面表现出相似的趋势。使用 DOAC 与颅内出血 [aHR, 0.65 (95% CI: 0.26-1.59)]和胃肠道出血 [aHR, 0.64 (95% CI: 0.39-1.03)]风险相似,大出血风险降低 [aHR, 0.64 (95% CI: 0.42-0.99)],死亡率降低 [aHR, 0.73 (95% CI: 0.54-0.99)]。使用DOAC的Child-Pugh A级患者的大出血风险明显降低(aHR,0.48;95% CI:0.33-0.70):结论:对于非瓣膜性房颤和低血糖患者,DOAC与华法林相比具有潜在的安全性优势,尤其是在降低Child-Pugh A级患者的大出血风险方面。
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来源期刊
Journal of clinical gastroenterology
Journal of clinical gastroenterology 医学-胃肠肝病学
CiteScore
5.60
自引率
3.40%
发文量
339
审稿时长
3-8 weeks
期刊介绍: Journal of Clinical Gastroenterology gathers the world''s latest, most relevant clinical studies and reviews, case reports, and technical expertise in a single source. Regular features include cutting-edge, peer-reviewed articles and clinical reviews that put the latest research and development into the context of your practice. Also included are biographies, focused organ reviews, practice management, and therapeutic recommendations.
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