*Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;†Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and‡Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Cardiovasc Pharmacol. 2017 Oct;70(4):255-262. doi: 10.1097/FJC.0000000000000513.
BACKGROUND & AIMS: To evaluate the clinical benefits and risks of anticoagulation with warfarin in cirrhotic patients with atrial fibrillation (AF).
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.
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).
Anticoagulation with warfarin in cirrhotic patients with AF may not significantly reduce the risk of ischemic stroke, whereas it increases hemorrhagic complications.
评估抗凝治疗在合并心房颤动（房颤）的肝硬化患者中的临床获益和风险。
共回顾性分析了 465 例诊断为非瓣膜性房颤的肝硬化患者。比较了两组缺血性卒中及大出血事件的发生率，并探讨了缺血性卒中或大出血事件的预测因素。
465 例房颤患者中，113 例（24.3%）接受了华法林治疗。与未使用者相比，华法林使用者的平均 Child-Pugh 评分较低（6.1 ± 1.5 比 7.6 ± 2.6），CHA2DS2VASc 评分较高（2.0 ± 2.5 比 1.7 ± 1.3）（P 值均＜0.05）。总体而言，合并房颤的肝硬化患者缺血性卒中发生率较低，且不依赖于 CHA2DS2VASc 评分（危险比 1.40；95%置信区间 0.96-2.05；P = 0.081），且在华法林使用者（0.9%/人年）和未使用者（1.2%/人年）中相当。然而，华法林使用者大出血事件发生率明显较高（5.9%比 2.6%）（P＜0.05）。多变量分析显示，华法林使用（2.60；95%置信区间 1.32-5.12）和 Child-Pugh 评分（1.25；1.04-1.49）是这些肝硬化患者出血事件的独立相关因素（P 值均＜0.05）。HAS-BLED 评分与大出血风险无相关性（1.20；0.95-1.52；P = 0.123）。
在合并房颤的肝硬化患者中，抗凝治疗华法林可能不会显著降低缺血性卒中风险，反而会增加出血并发症。
