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Review
. 2025 Jul-Aug;15(4):102534.
doi: 10.1016/j.jceh.2025.102534. Epub 2025 Feb 25.

Efficacy and Safety of Direct Oral Anticoagulants Compared to Vitamin K Antagonists for Atrial Fibrillation in Patients With Liver Cirrhosis: An Update Systematic Review and Meta-analysis

Maria C R Miranda  1 , Charles K M Santos  1 , Gabriel A Barbosa  1 , Antônio da Silva Menezes Júnior  1   2
Affiliations
Review

Efficacy and Safety of Direct Oral Anticoagulants Compared to Vitamin K Antagonists for Atrial Fibrillation in Patients With Liver Cirrhosis: An Update Systematic Review and Meta-analysis

Maria C R Miranda et al. J Clin Exp Hepatol. 2025 Jul-Aug.

Abstract

Background: This meta-analysis aimed to compare the efficacy and safety of direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in patients with concomitant atrial fibrillation (AF) and liver cirrhosis (LC).

Methods: PubMed, Cochrane Library, Embase, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI) databases were searched for randomized clinical trials (RCTs) and non-RCTs comparing DOACs and VKAs in patients with AF and LC. Analyses were performed in R software. A random-effects model was employed to calculate the pooled hazard ratio (HR).

Results: Eleven studies encompassing 19,617 patients were included, with 9379 receiving DOACs and 10,238 receiving VKAs. DOACs were associated with a significant reduction in the incidence of major bleeding (HR 0.70; 95% CI: 0.61-0.81; P < 0.001; I2 = 0%), all-cause mortality (HR 0.87; 95% CI: 0.78-0.98; P = 0.022; I2 = 41%), and gastrointestinal bleeding (HR 0.75; 95% CI: 0.67-0.84; P < 0.001; I2 = 4%). No significant difference was observed for thromboembolic events (HR 0.86; 95% CI: 0.69-1.06; P = 0.153; I2 = 0%).

Conclusion: DOACs may be a feasible option for patients with AF and LC, demonstrating similar effectiveness to VKAs while exhibiting a better safety profile. These findings await validation by prospective studies.

Keywords: atrial fibrillation; direct oral anticoagulants; liver cirrhosis; meta-analysis; vitamin K antagonists.

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Conflict of interest statement

The authors declare no conflict of interest.

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