Lee Zhi-Yan, Suah Boon-Hao, Teo Yao Hao, Teo Yao Neng, Syn Nicholas L X, Yeo Tiong-Cheng, Wong Raymond C C, Chai Ping, Wong Yu Jun, Ho Jamie S Y, Leow Aloysius Sheng-Ting, Yeo Leonard L L, Tan Benjamin Y Q, Sia Ching-Hui
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.
Am J Cardiovasc Drugs. 2022 Mar;22(2):157-165. doi: 10.1007/s40256-021-00482-w. Epub 2021 May 19.
Patients with atrial fibrillation (AF) have a higher risk of developing thromboembolic events. Current guidelines recommend the use of oral anticoagulants for stroke prevention in these patients. Several clinical trials demonstrated that direct oral anticoagulants (DOACs) have similar efficacy and are safer alternatives to traditional oral anticoagulants. However, patients with concomitant liver cirrhosis were excluded from these trials.
We aimed to systematically identify and review published clinical studies on the use of DOACs in patients with AF and liver cirrhosis and assess the efficacy and safety of DOACs in these patients.
A systematic review of clinical trials and retrospective studies was conducted by searching the PubMed, Cochrane Library, Embase, SCOPUS, and Web of Science databases up to September 2020.
Three retrospective studies were included, involving 4011 patients with AF and liver cirrhosis. The use of DOACs was associated with a significant reduction in ischemic stroke (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.42-0.90; p = 0.01), major bleeding events (HR 0.64; 95% CI 0.57-0.72; p < 0.001), and intracranial hemorrhage (HR 0.49; 95% CI 0.40-0.59; p < 0.001).
Compared with warfarin in patients with AF and liver cirrhosis, DOACs appear to be associated with improved efficacy and safety outcomes. Randomized controlled trials are warranted to confirm these findings.
心房颤动（AF）患者发生血栓栓塞事件的风险较高。当前指南推荐在这些患者中使用口服抗凝剂预防中风。多项临床试验表明，直接口服抗凝剂（DOACs）具有相似的疗效，是传统口服抗凝剂更安全的替代品。然而，这些试验排除了合并肝硬化的患者。
我们旨在系统地识别和综述已发表的关于DOACs在AF合并肝硬化患者中应用的临床研究，并评估DOACs在这些患者中的疗效和安全性。
通过检索截至2020年9月的PubMed、Cochrane图书馆、Embase、SCOPUS和科学网数据库，对临床试验和回顾性研究进行系统综述。
纳入三项回顾性研究，涉及4011例AF合并肝硬化患者。使用DOACs与缺血性中风显著减少相关（风险比[HR]0.62；95%置信区间[CI]0.42 - 0.90；p = 0.01），大出血事件（HR 0.64；95% CI 0.57 - 0.72；p < 0.001），以及颅内出血（HR 0.49；95% CI 0.40 - 0.59；p < 0.001）。
与华法林相比，在AF合并肝硬化患者中，DOACs似乎与更好的疗效和安全性结果相关。需要进行随机对照试验来证实这些发现。
