Anticoagulant prophylaxis in patients with liver disease and atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults worldwide. The use of oral anticoagulants (DOACs) is an effective way to prevent ischemic stroke in patients with AF, reducing the risk of stroke by approximately 64 %. In patients with liver cirrhosis (LC), the presence of AF is associated with higher rates of in-hospital mortality, stroke and acute kidney injury compared with patients without arrhythmia. Liver disease and especially cirrhosis are associated with an increased risk of not only thrombosis but also bleeding, making the decision about anticoagulant therapy in these patients very difficult. The article reviews the current literature regarding the use of modern DOACs and traditional antithrombotic agents, such as vitamin K antagonists and heparins, in patients with cirrhosis and AF.