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

• Published in: International journal of clinical practice (Esher) Vol. 75; no. 10; pp. e14585 - n/a
• Main Authors: Su, Taomin, Fu, Zheng, Nie, Zhihong, Guo, Dongfeng
• Format: Journal Article
• Language: English
• Published: London John Wiley & Sons, Inc 01.10.2021
• Subjects: Anticoagulants; Bleeding; Cardiac arrhythmia; Consumers; Consumption; Embolism; Embolisms; Fibrillation; Hemorrhage; Liver diseases; Meta-analysis; Mortality; Vitamin K; Warfarin
• ISSN: 1368-5031; 1742-1241; 1742-1241
• DOI: 10.1111/ijcp.14585

Introduction Many concerns were raised about the 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. Methods A systematic literature search up to July 2020 was performed and six studies included 50 074 subjects with atrial fibrillation and liver disease at the baseline with 32 229 non‐vitamin K antagonist oral anticoagulant consumers and 18 920 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. Results 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. Conclusions 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.