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Efficacy and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Liver Disease: a Meta-Analysis and Systematic Review
- Source :
- Cardiovascular Drugs and Therapy. 35:1205-1215
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Liver disease is associated with increased bleeding risk. The efficacy and safety of direct oral anticoagulants (DOACs) is a subject of contention in atrial fibrillation (AF) patients with liver disease. Electronic databases (PubMed, Embase, and Cochrane Library) were searched to retrieve studies on the efficacy and safety of DOACs versus warfarin in AF patients with liver disease from January 1980 to April 2020. A meta-analysis was conducted using a random-effects model. Six studies involving 41,859 patients were included. Compared with warfarin, DOACs demonstrated significant reduction in ischemic stroke (HR, 0.68; 95% CI (0.54–0.86)), major bleeding (0.74 (0.59–0.92)), and intracranial hemorrhage (ICH) (0.48 (0.40–0.58)), with no significant effect on gastrointestinal bleeding (P = 0.893) in AF patients with liver disease. Similar results were observed in regular-dose, reduced-dose, and active liver disease subgroups, albeit Asian patients had a slight reduction in major bleeding (P = 0.055). Furthermore, the pooled estimates of individual DOAC subgroups indicated that dabigatran and apixaban led to greater safety in major bleeding (P
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Gastrointestinal bleeding
Cirrhosis
Pyridones
Hemorrhage
030204 cardiovascular system & hematology
Cochrane Library
Gastroenterology
Antithrombins
Dabigatran
03 medical and health sciences
Liver disease
0302 clinical medicine
Internal medicine
Atrial Fibrillation
Humans
Medicine
Pharmacology (medical)
Pharmacology
Dose-Response Relationship, Drug
business.industry
Liver Diseases
Warfarin
Atrial fibrillation
General Medicine
medicine.disease
Stroke
030104 developmental biology
Pyrazoles
Apixaban
Cardiology and Cardiovascular Medicine
business
Factor Xa Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 15737241 and 09203206
- Volume :
- 35
- Database :
- OpenAIRE
- Journal :
- Cardiovascular Drugs and Therapy
- Accession number :
- edsair.doi.dedup.....4f709287a634345be5a77cc6d414f143