Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillation
Abstract Background Anticoagulation (AC) is used for stroke prevention in atrial fibrillation (AF). Direct Oral Anticoagulants (DOACs) are safe in patients with AF without cirrhosis, they are hardly studied in patients with advanced cirrhosis. Our study evaluates the safety and outcomes of DOACs in...
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| Language: | English |
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Wiley
2024-05-01
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| Series: | JGH Open |
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| Online Access: | https://doi.org/10.1002/jgh3.13074 |
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| author | Mark Ayoub Carol Faris Julton Tomanguillo Chumbe Ebubekir Daglilar Nadeem Anwar Vishnu Naravadi |
| author_facet | Mark Ayoub Carol Faris Julton Tomanguillo Chumbe Ebubekir Daglilar Nadeem Anwar Vishnu Naravadi |
| author_sort | Mark Ayoub |
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| description | Abstract Background Anticoagulation (AC) is used for stroke prevention in atrial fibrillation (AF). Direct Oral Anticoagulants (DOACs) are safe in patients with AF without cirrhosis, they are hardly studied in patients with advanced cirrhosis. Our study evaluates the safety and outcomes of DOACs in patients with Child‐Pugh class C cirrhosis (CPC). Methods We queried TriNetX Database. Patients with CPC and AF were divided into three cohorts: patients on DOACs, no AC, and warfarin. Three study arms were created using a 1:1 propensity score matching system (PSM). Results Totally 16 029 patients met the inclusion criteria. Of those, 20.2% (n = 3235) were on DOACs, 47.1% (n = 7552) were not on AC, and 32.7% (n = 5242) were on warfarin. First arm comparing AC versus no AC, a statistically significant benefit was identified in 3‐year mortality risk (47% vs 71%, P < 0.0001) and transplant status (17% vs 5%, p < 0.0001) with AC. However, no significant difference was identified regarding intracranial hemorrhage and GI bleeding risk. Second arm comparing patients on DOACs versus no AC, we identified mortality benefit (40% vs 72%, P < 0.0001) and a higher transplant rate (9% vs 3.2%, P < 0.0001) with DOACs. Intracranial hemorrhage rates (6% vs 4%, P = 0.03) were higher in patients on DOACs. Third arm comparing patients on DOACs versus Warfarin, a statistically significant lower risk of intracranial hemorrhage (6.6% vs 8.7%, P = 0.004) and GI bleed (2% vs 2.4%, P < 0.0001) were identified in patients on DOACs. Conclusion Anticoagulation is safe in patients with CPC with AF and may provide a mortality benefit. DOACs are a safer alternative to warfarin. |
| format | Article |
| id | doaj-art-e9404b3f4d6040dca671c3590b6e3db3 |
| institution | Kabale University |
| issn | 2397-9070 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | JGH Open |
| spelling | doaj-art-e9404b3f4d6040dca671c3590b6e3db32025-08-20T03:51:24ZengWileyJGH Open2397-90702024-05-0185n/an/a10.1002/jgh3.13074Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillationMark Ayoub0Carol Faris1Julton Tomanguillo Chumbe2Ebubekir Daglilar3Nadeem Anwar4Vishnu Naravadi5West Virginia University Charleston Division, Internal Medicine Department Charleston Area Medical Center Charleston West Virginia USAMarshall University School of Medicine Surgery Department Huntington West Virginia USAWest Virginia University Charleston Division, Internal Medicine Department Charleston Area Medical Center Charleston West Virginia USADepartment of Gastroenterology, Charleston Division West Virginia University School of Medicine, Charleston Area Medical Center Charleston West Virginia USADepartment of Gastroenterology, Charleston Division West Virginia University School of Medicine, Charleston Area Medical Center Charleston West Virginia USADepartment of Gastroenterology, Charleston Division West Virginia University School of Medicine, Charleston Area Medical Center Charleston West Virginia USAAbstract Background Anticoagulation (AC) is used for stroke prevention in atrial fibrillation (AF). Direct Oral Anticoagulants (DOACs) are safe in patients with AF without cirrhosis, they are hardly studied in patients with advanced cirrhosis. Our study evaluates the safety and outcomes of DOACs in patients with Child‐Pugh class C cirrhosis (CPC). Methods We queried TriNetX Database. Patients with CPC and AF were divided into three cohorts: patients on DOACs, no AC, and warfarin. Three study arms were created using a 1:1 propensity score matching system (PSM). Results Totally 16 029 patients met the inclusion criteria. Of those, 20.2% (n = 3235) were on DOACs, 47.1% (n = 7552) were not on AC, and 32.7% (n = 5242) were on warfarin. First arm comparing AC versus no AC, a statistically significant benefit was identified in 3‐year mortality risk (47% vs 71%, P < 0.0001) and transplant status (17% vs 5%, p < 0.0001) with AC. However, no significant difference was identified regarding intracranial hemorrhage and GI bleeding risk. Second arm comparing patients on DOACs versus no AC, we identified mortality benefit (40% vs 72%, P < 0.0001) and a higher transplant rate (9% vs 3.2%, P < 0.0001) with DOACs. Intracranial hemorrhage rates (6% vs 4%, P = 0.03) were higher in patients on DOACs. Third arm comparing patients on DOACs versus Warfarin, a statistically significant lower risk of intracranial hemorrhage (6.6% vs 8.7%, P = 0.004) and GI bleed (2% vs 2.4%, P < 0.0001) were identified in patients on DOACs. Conclusion Anticoagulation is safe in patients with CPC with AF and may provide a mortality benefit. DOACs are a safer alternative to warfarin.https://doi.org/10.1002/jgh3.13074anticoagulationatrial fibrillationChild‐Pugh Ccirrhosisdirect oral anticoagulantgastrointestinal bleed |
| spellingShingle | Mark Ayoub Carol Faris Julton Tomanguillo Chumbe Ebubekir Daglilar Nadeem Anwar Vishnu Naravadi Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillation JGH Open anticoagulation atrial fibrillation Child‐Pugh C cirrhosis direct oral anticoagulant gastrointestinal bleed |
| title | Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillation |
| title_full | Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillation |
| title_fullStr | Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillation |
| title_full_unstemmed | Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillation |
| title_short | Safety of DOACs in patients with Child‐Pugh Class C cirrhosis and atrial fibrillation |
| title_sort | safety of doacs in patients with child pugh class c cirrhosis and atrial fibrillation |
| topic | anticoagulation atrial fibrillation Child‐Pugh C cirrhosis direct oral anticoagulant gastrointestinal bleed |
| url | https://doi.org/10.1002/jgh3.13074 |
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