Risks Versus Benefits of Anticoagulation for Atrial Fibrillation in Cirrhotic Patients

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Background & Aims:To evaluate the clinical benefits and risks of anticoagulation with warfarin in cirrhotic patients with atrial fibrillation (AF).Methods:A total of 465 cirrhotic patients diagnosed with nonvalvular AF were retrospectively analyzed. We compared incidences of ischemic stroke and major bleeding events between the 2 groups and examined the factors predicting ischemic stroke or major bleeding events.Results:Of 465 patients with AF, 113 (24.3%) received warfarin. Warfarin users had a lower mean Child–Pugh score (6.1 ± 1.5 vs. 7.6 ± 2.6) and a higher mean CHA2DS2VASc score (2.0 ± 2.5 vs. 1.7 ± 1.3) than nonusers (P's < 0.05). Overall, the incidence of ischemic stroke was low in cirrhotic patients with AF. It was not dependent on the CHA2DS2VASc score (hazard ratio, 1.40; 95% confidence interval, 0.96–2.05; P = 0.081), and was comparable in warfarin users (0.9%/person-year) and nonusers (1.2%/person-year). However, the incidence of major bleeding events was significantly higher in warfarin users (5.9% vs. 2.6%; P < 0.05). A multivariate analysis identified warfarin use (2.60; 95% confidence interval, 1.32–5.12) and Child–Pugh score (1.25; 1.04–1.49) as independently associated with bleeding events in these cirrhotic patients (P's < 0.05). There was no correlation between HAS-BLED score and risk of major bleeding (1.20; 0.95–1.52; P = 0.123).Conclusions:Anticoagulation with warfarin in cirrhotic patients with AF may not significantly reduce the risk of ischemic stroke, whereas it increases hemorrhagic complications.

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