DOAC vs warfarin: Which agent is safer for AF patients with cirrhosis?

The use of direct oral anticoagulants (DOACs) appears to be safer than warfarin for patients with nonvalvular atrial fibrillation (AF) and liver cirrhosis (LC), suggests a study. This is particularly true to reducing the risk of major bleeding in those with Child-Pugh class A disease.

Researchers conducted a retrospective cohort study in the largest hospital system in Taiwan, involving patients with AF and LC from 2012 to 2021. They assessed the risks of thromboembolic events (ie, ischaemic stroke, transient ischaemic attack, and systemic embolism), intracranial haemorrhage, gastrointestinal, major bleeding, and all-cause mortality via an active comparator design.

Finally, potential confounders between treatment groups were balanced using inverse probability of treatment weighting.

A total of 478 DOAC users and 247 warfarin users were analysed. Both agents showed similar trends in preventing thromboembolic events, such as ischaemic stroke (adjusted hazard ratio [aHR], 1.05, 95 percent confidence interval [CI], 0.42‒2.61), transient ischaemic attack (aHR, 1.36, 95 percent CI, 0.18‒10.31), and systemic embolism (aHR, 0.49, 95 percent CI, 0.14‒1.70).

Treatment with DOACs correlated with a similar risk of intracranial haemorrhage (aHR, 0.65, 95 percent CI, 0.26‒1.59) and gastrointestinal bleeding (aHR, 0.64, 95 percent CI, 0.38‒1.03), a reduced risk of major bleeding (aHR, 0.64, 95 percent CI, 0.42‒0.99), and a decrease in mortality (aHR, 0.73, 95 percent CI, 0.54‒0.99).

Notably, among users of DOAC, a significant decrease in major bleeding risk was observed in those with Child-Pugh class A disease (aHR, 0.48, 95 percent CI, 0.33‒0.70).