SynthesisFrontiers in pharmacology2025
Effectiveness and safety of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with liver disease: a systematic review and meta-analysis.
Synthesis in Frontiers in pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- When Atrial Fibrillation Meets Alcoholic Liver Cirrhosis: Can Direct Oral Anticoagulants Bridge the Therapeutic Gap?Biomedicines · 2026Review
- Echocardiographic Guidance for Percutaneous Left Atrial Appendage Occlusion: A Systematic Review of Outcomes in High-Risk Populations Including Chronic Liver Disease and Prior Gastrointestinal Bleeding.Diagnostics (Basel, Switzerland) · 2026Review
- Type 2 Diabetes Is Associated with Increased Coagulation Activity in Patients with Atrial Fibrillation: A D-Dimer-Based Analysis.Biomedicines · 2026Article
- From empirical hemostasis to precision reversal: clinical challenges, technological innovations, and individualized strategies in anticoagulant-associated bleeding.Frontiers in cardiovascular medicine · 2026Review
- LAAEV-centric atrial failure phenotype and a novel integrative score for predicting early recurrence after AF ablation.Frontiers in cardiovascular medicine · 2026Article
- Impact of intracardiac echocardiography on radiofrequency catheter ablation for atrial fibrillation: a clinical study on procedural parameters and post-procedural recurrence.Frontiers in cardiovascular medicine · 2026Article
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8 authors.
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Abstract
Introduction: Patients with atrial fibrillation (AF) and liver disease, particularly cirrhosis, are frequently excluded from anticoagulation trials, leaving the optimal therapeutic strategy uncertain. Methods: This study aimed to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with AF and liver disease. We systematically searched the PubMed, Cochrane Library, Medline, and Embase databases for relevant studies published up to November 2024. Results: Fourteen studies, involving 44,848 participants, were included. Compared to VKAs, DOACs were associated with significantly lower risks of major bleeding (risk ratio [RR]: 0.64, 95% confidence interval [CI]: 0.55-0.75; P < 0.0001), intracranial bleeding (RR: 0.43, 95% CI: 0.33-0.56; P < 0.0001), gastrointestinal (GI) bleeding (RR: 0.72, 95% CI: 0.59-0.89; P = 0.002), and all-cause mortality (RR: 0.83, 95% CI: 0.70-0.98; P = 0.03). No significant difference was observed in ischemic stroke/systemic embolism (RR: 0.77, 95% CI: 0.52-1.13; P = 0.19). In patients with cirrhosis, DOACs were similarly superior for major bleeding, GI bleeding, and intracranial bleeding. Subgroup analyses revealed that apixaban demonstrated a more favorable safety profile than rivaroxaban in patients with liver disease, whereas both agents showed comparable effectiveness and safety in cirrhotic patients. Conclusion: DOACs are safer and equally effective alternatives to VKAs in patients with AF and liver disease, including those with cirrhosis. In patients with liver disease, apixaban may offer additional safety benefits compared with rivaroxaban. However, in patients with cirrhosis, the effectiveness and safety profiles of the two drugs are similar. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623387.
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