Atrial fibrillation (AF) is observed to be 15 times more common in patients with cirrhosis compared to the general population. Despite this high incidence, individuals with cirrhosis have been systematically excluded from randomized clinical trials evaluating anticoagulants in AF patients. To address this gap, researchers utilized two extensive U.S. insurance databases comprising nearly 25,000 patients with cirrhosis and new-onset nonvalvular AF. They conducted a propensity score–matched comparison between patients who began treatment with apixaban and those who initiated either rivaroxaban or warfarin.
Which anticoagulant do you use for atrial fibrillation in patients with cirrhosis
0%Warfarin
0%Apixaban
0%Rivaroxaban
The findings revealed that patients treated with apixaban had a significantly lower risk of major bleeding compared to those treated with rivaroxaban (5.1% vs. 8.7% annually) or warfarin (5.1% vs. 7.9% annually). There were no observed differences in the rates of ischemic embolic events (such as stroke) or all-cause mortality among the different oral anticoagulant groups.
This retrospective study, which emulates a randomized study design through the use of propensity-score matching to reduce confounding, provides crucial data on patients with cirrhosis and AF. Given the absence of randomized trials in this patient group, the association of apixaban with approximately a 3-percentage-point lower incidence of bleeding events annually should be a key consideration when selecting anticoagulation therapy for this high-risk population.
Thanks dr. Mazen for updating us as always