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The safety and efficacy of vitamin K antagonist in patients with atrial fibrillation and liver cirrhosis

Authors
 Seung-Jun Lee  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
Citation
 INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol.180 : 185-191, 2015 
Journal Title
INTERNATIONAL JOURNAL OF CARDIOLOGY
ISSN
 0167-5273 
Issue Date
2015
MeSH
Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications* ; Atrial Fibrillation/drug therapy ; Brain Ischemia/epidemiology* ; Brain Ischemia/etiology ; Female ; Follow-Up Studies ; Hemorrhage/epidemiology* ; Hemorrhage/etiology ; Humans ; Incidence ; Liver Cirrhosis/complications* ; Liver Cirrhosis/drug therapy ; Male ; Middle Aged ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Assessment ; Vitamin K/antagonists & inhibitors*
Keywords
Atrial fibrillation ; Hemorrhage ; Liver cirrhosis ; Oral anticoagulant ; Stroke ; Vitamin K antagonist
Abstract
BACKGROUND: Bleeding is a major concern in treatment of atrial fibrillation (AF) with vitamin K antagonist (VKA). This concern is more emphasized in patients with high bleeding risk such as liver cirrhosis (LC). METHODS AND RESULTS: We retrospectively analyzed incidence of stroke and major bleeding in 321 AF patients with LC, including early [Child-Pugh (CP)-A, n=215] and advanced [CP-B or C, n=106] LC according to VKA prescription. The CHA2DS2-VASc, HAS-BLED and MELD scores were higher in patients with VKA. CP score was positively correlated with HAS-BLED score (rho: 0.602). The incidence of major bleeding was higher in advanced LC than in early LC (14.5%/year vs. 4.9%/year, p<0.001). VKA reduced the risk of ischemic stroke in AF patients with LC, whereas it significantly increased the major bleeding risk. There was no difference in survival free from significant clinical events (SCEs) between the patients with or without VKA (p=0.91). On subgroup analysis, VKA was beneficial in early LC patients, as it decreased stroke without increasing major bleeding risk. However, in advanced LC patients, VKA significantly increased the risk of major bleeding, especially variceal origin, that overwhelms stroke reduction. As a result, VKA treatment reduced the risk of SCEs in early LC patients, whereas it increased the risk of SCEs in advanced LC. CONCLUSIONS: VKA treatment might be beneficial to reduce significant clinical events in the early LC but not in the advanced LC group. However to confirm this hypothesis, a prospective randomized study is needed.
Full Text
http://www.sciencedirect.com/science/article/pii/S016752731402364X
DOI
10.1016/j.ijcard.2014.11.183
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lee, Seung-Jun(이승준) ORCID logo https://orcid.org/0000-0002-9201-4818
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139368
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