期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 6, 期 6, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.116.005307
关键词
atrial fibrillation; intracranial hemorrhage; ischemic stroke; liver cirrhosis
资金
- Ministry of Science and Technology [MOST 104-2314-B-075-024-MY3]
- Taipei Veterans General Hospital [V105B-023]
Background-Patients with liver cirrhosis have been excluded from randomized clinical trials of oral anticoagulation therapy for stroke prevention in atrial fibrillation. We hypothesized that patients with liver cirrhosis would have a positive net clinical benefit for oral anticoagulation when used for stroke prevention in atrial fibrillation. Methods and Results-This study used the National Health Insurance Research Database in Taiwan. Among 289 559 atrial fibrillation patients aged >= 20 years, there were 10 336 with liver cirrhosis, and 9056 of them having a CHA(2)DS(2)-VASc score >= 2 were divided into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin. Patients with liver cirrhosis had a higher risk of ischemic stroke (hazard ratio=1.10, P=0.046) and intracranial hemorrhage (hazard ratio=1.20, P=0.043) compared with those without. Among patients with liver cirrhosis, patients taking antiplatelet therapy had a similar risk of ischemic stroke (hazard ratio=1.02, 95% CI=0.88-1.18) compared to those without antithrombotic therapies, but the risk was significantly lowered among warfarin users (hazard ratio=0.76, 95% CI=0.58-0.99). For intracranial hemorrhage, there were no significant differences between those untreated and those taking antiplatelet therapy or warfarin. The use of warfarin was associated with a positive net clinical benefit compared with being untreated or receiving only antiplatelet therapy. Conclusions-For atrial fibrillation patients with liver cirrhosis in the current analysis of an observational study, warfarin use was associated with a lower risk of ischemic stroke and a positive net clinical benefit compared with nontreatment, and thus, thromboprophylaxis should be considered for such patients.
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