B Riahi Emil, Adelborg Kasper, Pedersen Lars, Kristensen Søren R, Hansen Anette T, Sørensen Henrik T
Department of Clinical Epidemiology Aarhus University Hospital and Aarhus University Aarhus Denmark.
Department of Surgery Randers Regional Hospital Randers Denmark.
Res Pract Thromb Haemost. 2022 Feb 24;6(2):e12668. doi: 10.1002/rth2.12668. eCollection 2022 Feb.
We examined the impact of liver cirrhosis on the risk of thromboembolic events and bleeding complications in patients with atrial fibrillation or flutter (AFF).
This population-based cohort study used data from Danish health registries. We identified all patients with a first-time diagnosis of AFF during 1995 to 2015, and followed them from their AFF diagnosis until the end of 2016. Patients were categorized according to the presence or absence of liver cirrhosis. We computed incidence rates per 1000 person-years and hazard ratios (HRs) with 95% confidence intervals (CIs) based on Cox regression analyses, adjusting for age, CHADSVASc score, and Charlson Comorbidity Index score.
We identified 273 225 patients with AFF. Of these, 1463 (0.54%) had liver cirrhosis. During 0 to 5 years of follow-up, compared to patients without liver cirrhosis, patients with liver cirrhosis had higher incidence rates and hazards of ischemic stroke (29.7 vs 21.6; HR, 1.3; 95% CI, 1.1-1.6), venous thromboembolism (9.2 vs 5.5; HR, 1.5; 95% CI, 1.2-2.3), but not myocardial infarction (10.2 vs 11.2; HR, 0.9; 95% CI, 0.7-1.2). Patients with liver cirrhosis also had higher rates of hemorrhagic stroke (5.8 vs 3.3; HR, 1.7; 95% CI, 1.1-2.6), subdural hemorrhage (5.3 vs 1.6; HR, 3.2; 95% CI, 2.1-4.9), hemorrhage of the lung or urinary tract (24.6 vs 15.2; HR, 1.6; 95% CI, 1.3-2.0), and gastrointestinal hemorrhage (34.5 vs 10.4; HR, 3.3; 95% CI, 2.7-3.9).
In patients with AFF, liver cirrhosis was associated with an elevated risk of ischemic stroke, venous thromboembolism, and all evaluated bleeding complications.
我们研究了肝硬化对心房颤动或心房扑动（AFF）患者发生血栓栓塞事件和出血并发症风险的影响。
这项基于人群的队列研究使用了丹麦健康登记处的数据。我们确定了1995年至2015年间首次诊断为AFF的所有患者，并从其AFF诊断开始随访至2016年底。根据是否存在肝硬化对患者进行分类。我们基于Cox回归分析计算了每1000人年的发病率和风险比（HR）以及95%置信区间（CI），并对年龄、CHADSVASc评分和Charlson合并症指数评分进行了调整。
我们确定了273225例AFF患者。其中，1463例（0.54%）患有肝硬化。在0至5年的随访期间，与无肝硬化的患者相比，肝硬化患者发生缺血性卒中的发病率和风险更高（29.7对21.6；HR，1.3；95%CI，1.1 - 1.6）、静脉血栓栓塞（9.2对5.5；HR）
