Liver Cirrhosis in Patients With Atrial Fibrillation: Would Oral Anticoagulation Have a Net Clinical Benefit for Stroke Prevention?

Background: patients with liver cirrhosis have been excluded from randomized clinical trials of oral anticoagulation therapy for stroke prevention in atrial fibrillation. we hypothesized that patients with liver cirrhosis would have a positive net clinical benefit for oral anticoagulation when used for stroke prevention in atrial fibrillation.methods and results: this study used the national health insurance research database in taiwan. among 289 559 atrial fibrillation patients aged ≥20 years,there were 10 336 with liver cirrhosis,and 9056 of them having a cha2ds2-vasc score ≥2 were divided into 3 groups,that is,no treatment,antiplatelet therapy,and warfarin. patients with liver cirrhosis had a higher risk of ischemic stroke (hazard ratio=1.10,p=0.046) and intracranial hemorrhage (hazard ratio=1.20,p=0.043) compared with those without. among patients with liver cirrhosis,patients taking antiplatelet therapy had a similar risk of ischemic stroke (hazard ratio=1.02,95%ci=0.88-1.18) compared to those without antithrombotic therapies,but the risk was significantly lowered among warfarin users (hazard ratio=0.76,95%ci=0.58-0.99). for intracranial hemorrhage,there were no significant differences between those untreated and those taking antiplatelet therapy or warfarin. the use of warfarin was associated with a positive net clinical benefit compared with being untreated or receiving only antiplatelet therapy.conclusions: for atrial fibrillation patients with liver cirrhosis in the current analysis of an observational study,warfarin use was associated with a lower risk of ischemic stroke and a positive net clinical benefit compared with nontreatment,and thus,thromboprophylaxis should be considered for such patients. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.