Abstract
Several studies have investigated the effectiveness and safety of nonvitamin K antagonist oral anticoagulants (NOACs) vs vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and liver disease. Herein, we conducted a meta‐analysis to compare the effect of NOACs with VKAs in patients with AF and liver disease. We also conducted a subsidiary analysis to compare the risk of liver injury between NOACs and VKA in AF patients. We systematically searched the PubMed and Embase databases from January 2009 to May 2020 for the relevant studies. Hazard ratios (HRs) with 95% confidence intervals (CIs) were selected and pooled using a random‐effects model. A total of six cohorts were included. Compared with VKA use, the use of NOACs was associated with reduced risks of stroke or systemic embolism (HR 0.68, 95% CI 0.49‐0.93), all‐cause death (HR 0.69, 95% CI 0.63‐0.75), and intracranial bleeding (HR 0.49, 95% CI 0.40‐0.59), whereas the outcomes of major bleeding (HR 0.72, 95% CI 0.51‐1.01) and gastrointestinal bleeding (HR 0.84, 95% CI 0.51‐1.36) were not significantly different between groups in AF patients with liver disease. Moreover, compared with VKA use, the use of NOACs was associated with a reduced risk of liver injury (HR 0.72, 95% CI 0.61‐0.84) in AF patients. Compared with VKAs, the use of NOACs was associated with reduced risks of stroke or systemic embolism, all‐cause death, and intracranial bleeding in AF patients with liver disease, and associated with a reduced risk of liver injury in AF patients.
Highlights
Atrial fibrillation (AF) represents one of the most common arrhythmias, resulting in an increased risk of thromboembolic events.[1]
There was no difference in the risk of stroke or systemic embolism (HR 0.81, 95% confidence interval (CI) 0.57-1.15) between Nonvitamin K antagonist oral anticoagulants (NOACs) vs vitamin K antagonists (VKAs)
We performed the subgroup analysis based on the NOACs type, suggesting that compared with VKA use, the use of dabigatran (HR 0.54, 95% CI 0.44-0.67), rivaroxaban (HR 0.82, 95% CI 0.70-0.96), or apixaban (HR 0.65, 95% CI 0.45-0.95) had a lower risk of liver injury in AF patients (Figure S2)
Summary
Atrial fibrillation (AF) represents one of the most common arrhythmias, resulting in an increased risk of thromboembolic events.[1]. Emerging pieces of evidence from case reports and pharmacovigilance analyses have detected a hepatotoxic potential in the NOAC users.[16,17] Current guidelines recommend annual monitoring of liver function during the use of NOACs.[2,3] More recently, two observational studies[18,19] have assessed the risk of liver injury associated with the use of NOACs. the second section of this metaanalysis aimed to explore the risk of liver injury of NOACs compared with VKAs in AF patients
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