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Review
. 2023 Mar 18;13(6):1160.
doi: 10.3390/diagnostics13061160.

Anticoagulation for Atrial Fibrillation in Patients with Decompensated Liver Cirrhosis: Bold and Brave?

Irina Gîrleanu  1   2 , Anca Trifan  1   2 , Laura Huiban  1   2 , Cristina Maria Muzica  1   2 , Oana Cristina Petrea  1   2 , Ana-Maria Sîngeap  1   2 , Camelia Cojocariu  1   2 , Stefan Chiriac  1   2 , Tudor Cuciureanu  1   2 , Remus Stafie  1   2 , Sebastian Zenovia  1   2 , Ermina Stratina  1   2 , Adrian Rotaru  1   2 , Robert Nastasa  1   2 , Catalin Sfarti  1   2 , Irina Iuliana Costache  1   3 , Carol Stanciu  1   2
Affiliations
Review

Anticoagulation for Atrial Fibrillation in Patients with Decompensated Liver Cirrhosis: Bold and Brave?

Irina Gîrleanu et al. Diagnostics (Basel). .

Abstract

Atrial fibrillation is frequently diagnosed in patients with liver cirrhosis, especially in those with non-alcoholic steatohepatitis or alcoholic etiology. Anticoagulant treatment is recommended for thromboembolic protection in patients with atrial fibrillation. Considering the impaired coagulation balance in liver cirrhosis, predisposing patients to bleed or thrombotic events, the anticoagulant treatment is still a matter of debate. Although patients with liver cirrhosis were excluded from the pivotal studies that confirmed the efficacy and safety of the anticoagulant treatment in patients with atrial fibrillation, data from real-life cohorts demonstrated that the anticoagulant treatment in patients with liver cirrhosis could be safe. This review aimed to evaluate the recent data regarding the safety and efficacy of anticoagulant treatment in patients with decompensated liver cirrhosis. Direct oral anticoagulants are safer than warfarin in patients with compensated liver cirrhosis. In Child-Pugh class C liver cirrhosis, direct oral anticoagulants are contraindicated. New bleeding and ischemic risk scores should be developed especially for patients with liver cirrhosis, and biomarkers for bleeding complications should be implemented in clinical practice to personalize this treatment in a very difficult population represented by decompensated liver cirrhosis patients.

Keywords: anticoagulation; atrial fibrillation; bleeding; liver cirrhosis; risk factors; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Physiopathology of atrial fibrillation in liver cirrhosis.
Figure 2
Figure 2
Coagulation balance in patients with liver cirrhosis.
See this image and copyright information in PMC

References

    1. Darrat Y.H., Smer A., Elayi C.S., Morales G.X., Alqahtani F., Alkhouli M., Catanzaro J., Shah J., Salih M. Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis. World J. Cardiol. 2020;12:342–350. doi: 10.4330/wjc.v12.i7.342. - DOI - PMC - PubMed
    1. Adejumo A.C., Adejumo K.L., Akanbi O., Adegbala O.M., Alayo Q.A., Fijabi D.O., Ogundipe O.A., Almaddah N., Pani L., Adeboye A. Predictors, burden and impact of cardiac arrhythmias among patients hospitalized with end-stage liver disease. Heart Lung. 2020;49:73–79. doi: 10.1016/j.hrtlng.2019.07.002. - DOI - PubMed
    1. Luo Y., Wu B., Wu Y., Peng L., Li Z., Zhu J., Su Z., Liu J., Li S., Chong Y. Atrial fibrillation increases inpatient and 4-year all-cause mortality in critically ill patients with liver cirrhosis. Ann. Transl. Med. 2021;9:1239. doi: 10.21037/atm-21-3111. - DOI - PMC - PubMed
    1. Chokesuwattanaskul R., Thongprayoon C., Bathini T., A O’Corragain O., Sharma K., Preechawat S., Wijarnpreecha K., Kröner P.T., Ungprasert P., Cheungpasitporn W. Epidemiology of atrial fibrillation in patients with cirrhosis and clinical significance: A meta-analysis. Eur. J. Gastroenterol. Hepatol. 2019;31:514–519. doi: 10.1097/MEG.0000000000001315. - DOI - PubMed
    1. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C., Boriani G., Castella M., Dan G.A., Dilaveris P.E., et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) Eur. Heart J. 2021;42:373–498. doi: 10.1093/eurheartj/ehaa612. - DOI - PubMed

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