Efficacy and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Liver Disease: a Meta-Analysis and Systematic Review

EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis

“…In the subgroup with cirrhosis (n = 3,111), the risks of major bleeding (RR 0.53; 95% CI 0.37-0.76), gastrointestinal bleeding (RR 0.57; 95% CI 0.38-0.84), and intracranial haemorrhage (RR 0.55; 95% CI 0.31-0.97) were significantly reduced when compared with warfarin. Similar results in terms of bleeding and occurrence of ischaemic stroke were obtained by Menichelli et al 309 while a decreased occurrence of ischaemic stroke was reported by Huang et al 310 Can vitamin K agonists or LMWH be used in the treatment of DVT/PE in patients with cirrhosis?…”

Cardiovascular Considerations in Patients with Liver Cirrhosis

“…These studies have shown use of DOAC to be safe and effective in patients with liver cirrhosis and AF. [38][39][40] Furthermore, these analyses demonstrated lower rates of bleeding events in DOACs compared with VKAs. These results indicate DOACs as the likely choice for anticoagulation in cirrhotic patients.…”

Non-Vitamin K Antagonists Versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Valves: A Systematic Review and Meta-Analysis

“…21 Other studies have suggested a lower risk of major bleeding in patients with atrial fibrillation treated with NOACs, particularly in those with comorbidities or a prior history of intracranial hemorrhage. [22][23][24][25][26] A key point in mitigating the risk of major bleeding in patients who are anticoagulated is to avoid the concomitant use of aspirin when not indicated. Until recently, all patients with bioprosthetic or mechanical valves were recommended to use aspirin.…”