School of Medicine, Jiangxi University of Technology, Nanchang, China.
Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241301402. doi: 10.1177/10760296241301402.
Currently, there is limited evidence regarding the use of direct oral anticoagulants (DOACs) for patients with liver cirrhosis (LC). We performed a meta-analysis to compare the efficacy and safety of DOACs versus warfarin in this population.
We searched PubMed, Cochrane Library, Web of Science, Embase and Scopus databases from inception to August 2024. Clinical studies comparing the use of DOACs with warfarin in cirrhotic patients were included. Hazard ratios (HRs) with 95% CIs were estimated by either fixed or random effects models. Primary efficacy outcomes were ischemic stroke/thromboembolism (IS/TE) and all-cause death, the primary safety outcomes were the bleeding risks.
Sixteen studies were included (16 829 individuals). DOACs had similar benefits in preventing IS/TE (HR = 0.87, 95% CI: 0.69-1.10), but DOACs were significantly associated with reduced risk of all-cause death (HR = 0.87, 95% CI: 0.79-0.97). On the other hand, we observed significantly reduced risks of any bleeding (HR = 0.60; 95%CI: 0.37-0.95), major bleeding (HR = 0.72; 95%CI: 0.63-0.82), intracranial hemorrhage (ICH) (HR = 0.47; 95%CI: 0.30-0.73), and gastrointestinal bleeding (GIB) (HR = 0.72, 95% CI: 0.60-0.87) in patients receiving DOACs. Results were consistent in cirrhotic patients with AF. Furthermore, DOACs reduced the incidence of major bleeding (HR = 0.65, 95%CI: 0.55-0.78) and ICH (HR = 0.17, 95%CI: 0.04-0.76) in patients with moderate to severe cirrhosis.
Our study demonstrates that DOACs, compared with warfarin, exerted comparable efficacy and better safety and may represent a safer alternative to warfarin in cirrhotic patients.
目前，关于直接口服抗凝剂（DOACs）在肝硬化（LC）患者中的应用，证据有限。我们进行了一项荟萃分析，以比较 DOACs 与华法林在该人群中的疗效和安全性。
我们检索了 PubMed、Cochrane 图书馆、Web of Science、Embase 和 Scopus 数据库，检索时间从建库至 2024 年 8 月。纳入比较 DOACs 与华法林在肝硬化患者中应用的临床研究。采用固定或随机效应模型估计风险比（HR）及其 95%置信区间。主要疗效结局为缺血性卒中和血栓栓塞（IS/TE）及全因死亡，主要安全性结局为出血风险。
共纳入 16 项研究（16829 人）。DOACs 在预防 IS/TE 方面具有相似的益处（HR=0.87，95%CI：0.69-1.10），但 DOACs 与全因死亡风险降低显著相关（HR=0.87，95%CI：0.79-0.97）。另一方面，我们观察到任何出血（HR=0.60；95%CI：0.37-0.95）、大出血（HR=0.72；95%CI：0.63-0.82）、颅内出血（ICH）（HR=0.47；95%CI：0.30-0.73）和胃肠道出血（GIB）（HR=0.72，95%CI：0.60-0.87）风险显著降低。在接受 DOACs 的肝硬化合并 AF 患者中，结果一致。此外，DOACs 降低了中重度肝硬化患者大出血（HR=0.65，95%CI：0.55-0.78）和 ICH（HR=0.17，95%CI：0.04-0.76）的发生率。
我们的研究表明，与华法林相比，DOACs 具有相当的疗效和更好的安全性，在肝硬化患者中可能是华法林更安全的替代药物。
