Blood thinners may protect liver disease patients from organ failure
A Swedish study of 1,160 patients found that anticoagulants reduced the risk of hepatic decompensation by 38% in people with cirrhosis and irregular heartbeat. The finding suggests a previously underappreciated benefit of these drugs and could reshape treatment guidelines for a vulnerable patient population facing dual organ risks.
Originaltitel: Oral anticoagulants and hepatic decompensation in patients with cirrhosis and atrial fibrillation: observational study.
Perorala antikoagulantia minskar risken för hepatisk dekompensation hos patienter med kompenserad cirros och förmaksflimmer, enligt en nationell svensk kohortanalys från Karolinska Institutet. Studien följde 1 160 patienter (median ålder 73 år) mellan 2011 och 2022 och jämförde behandlade och obehandlade grupper under fem år. Antikoagulantiainitiering var associerad med 38 procent lägre dekompensationsrisk (10,4 procent mot 16,6 procent), främst genom reducerad ascitesbildning. Blödningsrisken skilde sig inte mellan grupperna (19,0 procent mot 19,8 procent). Resultaten från registerdata föreslår att perorala antikoagulantia är säkra och kan förbättra prognosen för denna högrisikgrupp. Regulatoriska myndigheter och sjukvårdsledningar kan använda detta för att revidera behandlingsriktlinjer. Randomiserade studier krävs dock för att bekräfta effekten innan denna patientgrupp kan rekommenderas medicinering rutinmässigt.
BACKGROUND/AIMS: Oral anticoagulants may reduce risk of hepatic decompensation in patients with compensated cirrhosis, but well-powered randomized trials are missing. We aimed to estimate the effect of oral anticoagulants on risk of hepatic decompensation and major bleeding in patients with compensated cirrhosis and atrial fibrillation. METHODS: Observational data from Swedish healthcare registers 2011-2022 were used to emulate a target trial of oral anticoagulants in patients with compensated cirrhosis and newly diagnosed atrial fibrillation. Inverse-probability weighted marginal structural models were used to compare 5-year risks of hepatic decompensation and non-portal hypertension-related major bleeding in initiators versus non-initiators of oral anticoagulants. RESULTS: The study included 1,160 patients (715 men [61.6%]; median [p25-p75] age of 73 years [67-79]). The 5-year risk of hepatic decompensation was 10.4% (33/383) in initiators and 16.6% (112/777) in non-initiators (risk ratio [RR]=0.62, 95% confidence interval [CI]=0.33-0.92), corresponding to a number needed to treat of 17 (95%CI=9-112). The risk reduction was primarily driven by a reduced risk of ascites (RR=0.58, 95%CI=0.26-0.90). The risk of major bleeding was 19.0% (63/383) in initiators and 19.8% (149/777) in non-initiators (RR=0.96, 95%CI=0.64-1.28). Risks were similar between treatment groups regarding fatal, intracranial, gastrointestinal, and other bleedings. CONCLUSIONS: In this nationwide observational study, patients with compensated cirrhosis and atrial fibrillation who initiated oral anticoagulants had lower risk of hepatic decompensation, and similar risk of major bleeding compared to non-initiators. The results suggest oral anticoagulants are safe in patients with compensated cirrhosis and may improve prognosis. Randomized trials are warranted to confirm these results.