Department of Hepatology, The Fourth Hospital of Huai'an, Huai'an, Jiangsu, China.
Acta Clin Belg. 2023 Jun;78(3):234-244. doi: 10.1080/17843286.2022.2108259. Epub 2022 Aug 1.
Direct oral anticoagulants (DOACs), such as apixaban, edoxaban, rivaroxaban, or dabigatran, are an effective treatment for atrial fibrillation (AF) and deep venous thromboembolism. We hope to evaluate the safety of DOACs versus warfarin/low molecular weight heparin (LMWH) in improving bleeding events in patients with different severity of the liver disease.
We systematically searched the Cochrane Library, PubMed, and Embase databases for studies reporting the effects of DOACs in patients with liver cirrhosis. A random-effects model or fixed-effects model was selected to pool risk ratios (RR) and 95% confidence intervals (CI).
A total of 18 studies involving 41,447 participants was included in this meta-analysis. Compare with warfarin/ LMWH, the use of DOACs significantly reduced the incidence of all bleeding (RR: 0.76; 95%CI: 0.66 to 0.87), major bleeding (RR: 0.51; 95%CI: 0.28 to 0.91), intracranial hemorrhage (RR: 0.50; 95%CI: 0.31 to 0.81), and gastrointestinal bleeding (RR: 0.76, 95% CI: 0.60 to 0.97), and all-cause death in patients with liver disease (RR: 0.77; 95%CI: 0.62 to 0.95). Similar results were observed in atrial fibrillation patients with liver disease and cirrhosis subgroups. Furthermore, the pooled estimates of the Child-Turcotte-Pugh (CTP) class indicated that DOACs reduced the incidence of all bleeding (RR: 0.61; 95%CI: 0.45 to 0.82), gastrointestinal bleeding (RR 0.55; 95%CI: 0.37 to 0.83), and all-cause death (RR: 0.62; 95%CI: 0.49 to 0.79) in patients with mild to moderate cirrhosis.
Our study demonstrates that DOACs significantly reduce the risk of bleeding in patients with liver disease compared with warfarin/LMWH.
直接口服抗凝剂（DOACs），如阿哌沙班、依度沙班、利伐沙班或达比加群，是治疗心房颤动（AF）和深静脉血栓形成的有效方法。我们希望评估 DOACs 与华法林/低分子肝素（LMWH）相比，在改善不同严重程度肝病患者出血事件方面的安全性。
我们系统地检索了 Cochrane 图书馆、PubMed 和 Embase 数据库，以查找报告 DOACs 在肝硬化患者中疗效的研究。选择随机效应模型或固定效应模型来汇总风险比（RR）和 95%置信区间（CI）。
共有 18 项研究纳入了 41447 名参与者，纳入了这项荟萃分析。与华法林/LMWH 相比，使用 DOACs 可显著降低所有出血（RR：0.76；95%CI：0.66 至 0.87）、主要出血（RR：0.51；95%CI：0.28 至 0.91）、颅内出血（RR：0.50；95%CI：0.31 至 0.81）和胃肠道出血（RR：0.76，95%CI：0.60 至 0.97）的发生率，以及肝病患者的全因死亡率（RR：0.77；95%CI：0.62 至 0.95）。在肝病和肝硬化亚组的房颤患者中也观察到类似的结果。此外，Child-Turcotte-Pugh（CTP）分级的汇总估计表明，DOACs 降低了所有出血（RR：0.61；95%CI：0.45 至 0.82）、胃肠道出血（RR：0.55；95%CI：0.37 至 0.83）和全因死亡率（RR：0.62；95%CI：0.49 至 0.79）的风险。
我们的研究表明，与华法林/LMWH 相比，DOACs 可显著降低肝病患者出血的风险。
