Steensig, Kamilla, Pareek, Manan, Krarup, Anne Lund 
ORCID: 0000-0002-2228-7132, Sogaard, Peter, Maeng, Michael, Tayal, Bhupendar, Lee, Christina Ji-Young, Torp-Pedersen, Christian, Lip, Gregory Yh ORCID: 0000-0002-7566-1626, Holland-Fischer, Peter et al (show 1 more authors)
(2022)
Thromboembolism and bleeding in patients with atrial fibrillation and liver disease - A nationwide register-based cohort study: Thromboembolism and bleeding in liver disease.
Clinics and research in hepatology and gastroenterology, 46 (8).
101952-.
Abstract
<h4>Background</h4>Balancing the risk of thromboembolism and bleeding in patients with liver disease and atrial fibrillation/flutter is particularly challenging.<h4>Purpose</h4>To examine the risks of thromboembolism and bleeding with use/non-use of oral anticoagulation (including vitamin K-antagonists and direct oral anticoagulants) in patients with liver disease and AF.<h4>Methods</h4>Danish nationwide register-based cohort study of anticoagulant naive individuals with liver disease, incident atrial fibrillation/flutter, and a CHA<sub>2</sub>DS<sub>2</sub>-VASc-score≥1 (men) or ≥2 (women), alive 30 days after atrial fibrillation/flutter diagnosis. Thromboembolism was a composite of ischaemic stroke, transient ischaemic attack, or venous thromboembolism. Bleeding was a composite of gastrointestinal, intracerebral, or urogenital bleeding requiring hospitalisation, or epistaxis requiring emergency department visit or hospital admission. Cause-specific Cox-regression was used to estimate absolute risks and average risk ratios standardised to covariate distributions. Because of significant interactions with anticoagulants, results for thromboembolism were stratified for CHA2DS2-VASc-score, and results for bleeding were stratified for cirrhotic/non-cirrhotic liver disease.<h4>Results</h4>Four hundred and nine of 1,238 patients with liver disease and new atrial fibrillation/flutter initiated anticoagulants. Amongst patients with a CHA2DS2-VASc-score of 1-2 (2-3 for women), five-year thromboembolism incidence rates were low and similar in the anticoagulant (6.5%) versus no anticoagulant (5.5%) groups (average risk ratio 1.19 [95%CI, 0.22-2.16]). In patients with a CHA2DS2-VASc-score>2 (>3 for women), incidence rates were 16% versus 24% (average risk ratio 0.66 [95%CI, 0.45-0.87]). Bleeding risks appeared higher amongst patients with cirrhotic versus non-cirrhotic disease but were not significantly affected by anticoagulant status.<h4>Conclusion</h4>Oral anticoagulant initiation in patients with liver disease, incident new atrial fibrillation/flutter, and a high CHA2DS2-VASc-score was associated with a reduced thromboembolism risk. Bleeding risk was not increased with anticoagulation, irrespective of the type of liver disease.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Liver Diseases, Brain Ischemia, Atrial Fibrillation, Thromboembolism, Hemorrhage, Vitamin K, Anticoagulants, Risk Assessment, Risk Factors, Cohort Studies, Female, Male, Stroke |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 09 Oct 2023 13:56 |
| Last Modified: | 09 Oct 2023 13:56 |
| DOI: | 10.1016/j.clinre.2022.101952 |
| Open Access URL: | https://doi.org/10.1016/j.clinre.2022.101952 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173558 |
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