Warfarin compared with non-vitamin K antagonist oral anticoagulants in subjects with liver disease and atrial fibrillation: A meta-analysis.

Abstract

Many concerns were raised aboutthe outcome of non-vitamin K antagonist oral anticoagulants compared with warfarin in subjects with atrial fibrillation and liver disease. However, the reported relationship between their efficacy and safety was variable. This meta-analysis was performed to evaluate this relationship. A systematic literature search up to July 2020 was performed and six studies included 50074 subjects with atrial fibrillation and liver disease at the baseline with 32229 non-vitamin K antagonist oral anticoagulant consumers and 18920 warfarin consumers. They were reporting relationships between non-vitamin K antagonist oral anticoagulants and warfarin in subjects with atrial fibrillation and liver disease. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated to evaluate the prognostic role of the efficacy and safety of non-vitamin K antagonist oral anticoagulants compared with warfarin in subjects with atrial fibrillation and liver disease subjects using the dichotomous method with a random or fixed-effect model. Non-vitamin K antagonist oral anticoagulants consumption was significantly related to lower all-cause mortality in subjects with atrial fibrillation and liver disease (OR, 0.90; 95% CI, 0.81-0.99, P=.03); lower intracranial haemorrhage (OR, 0.67; 95% CI, 0.55- 0.82, P<.001) and low stroke and system embolism (OR, 0.76; 95% CI, 0.68-0.86, P<.001) compared with warfarin consumption. However, non-vitamin K antagonist oral anticoagulants consumption was not significantly related to lower major bleeding in subjects with atrial fibrillation and liver disease (OR, 0.73; 95% CI, 0.52-1.02, P=.06); and gastrointestinal bleeding (OR, 0.93; 95% CI, 0.58-1.49, P=.77) compared with warfarin consumption. Based on this meta-analysis, non-vitamin K antagonist oral anticoagulant consumption may have an independent lower risk relationship with all-cause mortality, intracranial haemorrhage, and stroke and system embolism compared with warfarin consumption in subjects with atrial fibrillation and liver disease. This relationship forces us to recommend non-vitamin K antagonist oral anticoagulant use in subjects with atrial fibrillation and liver disease for better outcomes and to avoid any possible complications. Further studies are required.