TY - JOUR
T1 - Impact of Liver Disease on Oral Anticoagulant Prescription and Major Adverse Events in Patients with Atrial Fibrillation
T2 - analysis from a population-based cohort study
AU - Proietti, Marco
AU - Marzona, Irene
AU - Vannini, Tommaso
AU - Colacioppo, Pierluca
AU - Tettamanti, Mauro
AU - Foresta, Andreana
AU - Fortino, Ida
AU - Merlino, Luca
AU - Lip, Gregory Y H
AU - Roncaglioni, Maria Carla
PY - 2021/4
Y1 - 2021/4
N2 - AIMS: Data on the impact of liver disease (LD) in patients with atrial fibrillation (AF) and the role of oral anticoagulant (OAC) drugs for stroke prevention, are limited.METHODS: A retrospective observational population-based cohort study on the administrative health databases of Lombardy region Italy. All AF patients ≥40 years admitted to hospital from 2000 to 2018 were considered. AF and LD diagnosis were established using ICD9-CM codes. Use of OAC was determined with Anatomical Therapeutic Chemical (ATC) codes. Primary study outcomes were stroke, major bleeding and all-cause death.RESULTS: Among 393,507 AF patients, 16,168 (4.1%) had concomitant LD. LD AF patients were significantly less treated with OAC. Concomitant LD was associated with an increased risk in all the study outcomes (HR: 1.18, 95% CI: 1.11-1.25 for stroke; HR: 1.57, 95% CI: 1.47-1.66 for major bleeding; HR: 1.41, 95% CI: 1.39-1.44 for all-cause death). Use of OAC in patients with AF and LD resulted in a reduction in stroke (HR: 0.80, 95% CI: 0.70-0.92), major bleeding (HR: 0.86, 95% CI: 0.74-0.99) and all-cause death (HR: 0.77, 95% CI: 0.73-0.80), with similar results according to subgroups. A net clinical benefit (NCB) analysis suggested a positive benefit/risk ratio in using OAC in AF patients with LD (NCB: 0.408, 95% CI: 0.375-0.472).CONCLUSIONS: In AF patients, concomitant LD carries a significantly higher risk for all clinical outcomes. Use of OAC in AF patients with LD was associated with a significant benefit/risk ratio, even in high-risk patient subgroups.
AB - AIMS: Data on the impact of liver disease (LD) in patients with atrial fibrillation (AF) and the role of oral anticoagulant (OAC) drugs for stroke prevention, are limited.METHODS: A retrospective observational population-based cohort study on the administrative health databases of Lombardy region Italy. All AF patients ≥40 years admitted to hospital from 2000 to 2018 were considered. AF and LD diagnosis were established using ICD9-CM codes. Use of OAC was determined with Anatomical Therapeutic Chemical (ATC) codes. Primary study outcomes were stroke, major bleeding and all-cause death.RESULTS: Among 393,507 AF patients, 16,168 (4.1%) had concomitant LD. LD AF patients were significantly less treated with OAC. Concomitant LD was associated with an increased risk in all the study outcomes (HR: 1.18, 95% CI: 1.11-1.25 for stroke; HR: 1.57, 95% CI: 1.47-1.66 for major bleeding; HR: 1.41, 95% CI: 1.39-1.44 for all-cause death). Use of OAC in patients with AF and LD resulted in a reduction in stroke (HR: 0.80, 95% CI: 0.70-0.92), major bleeding (HR: 0.86, 95% CI: 0.74-0.99) and all-cause death (HR: 0.77, 95% CI: 0.73-0.80), with similar results according to subgroups. A net clinical benefit (NCB) analysis suggested a positive benefit/risk ratio in using OAC in AF patients with LD (NCB: 0.408, 95% CI: 0.375-0.472).CONCLUSIONS: In AF patients, concomitant LD carries a significantly higher risk for all clinical outcomes. Use of OAC in AF patients with LD was associated with a significant benefit/risk ratio, even in high-risk patient subgroups.
KW - Atrial fibrillation
KW - Liver disease
KW - Oral anticoagulant treatment
UR - http://www.scopus.com/inward/record.url?scp=85083766149&partnerID=8YFLogxK
U2 - 10.1093/ehjcvp/pvaa015
DO - 10.1093/ehjcvp/pvaa015
M3 - Journal article
C2 - 32129845
SN - 2055-6837
VL - 7
SP - f84–f92
JO - European heart journal. Cardiovascular pharmacotherapy
JF - European heart journal. Cardiovascular pharmacotherapy
IS - FI1
M1 - pvaa015
ER -