Safety of direct oral anticoagulants in patients with liver disease: a systematic review and meta-analysis.

IF 1.6 4区医学 Q2 Medicine

Acta Clinica Belgica Pub Date : 2023-06-01 DOI:10.1080/17843286.2022.2108259

Yan Zhao, Liyao Zhu, Yang Yang, Han Gao, Rui Zhang

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引用次数: 0

Abstract

Background: Direct oral anticoagulants (DOACs), such as apixaban, edoxaban, rivaroxaban, or dabigatran, are an effective treatment for atrial fibrillation (AF) and deep venous thromboembolism. We hope to evaluate the safety of DOACs versus warfarin/low molecular weight heparin (LMWH) in improving bleeding events in patients with different severity of the liver disease.

Methods: We systematically searched the Cochrane Library, PubMed, and Embase databases for studies reporting the effects of DOACs in patients with liver cirrhosis. A random-effects model or fixed-effects model was selected to pool risk ratios (RR) and 95% confidence intervals (CI).

Results: A total of 18 studies involving 41,447 participants was included in this meta-analysis. Compare with warfarin/ LMWH, the use of DOACs significantly reduced the incidence of all bleeding (RR: 0.76; 95%CI: 0.66 to 0.87), major bleeding (RR: 0.51; 95%CI: 0.28 to 0.91), intracranial hemorrhage (RR: 0.50; 95%CI: 0.31 to 0.81), and gastrointestinal bleeding (RR: 0.76, 95% CI: 0.60 to 0.97), and all-cause death in patients with liver disease (RR: 0.77; 95%CI: 0.62 to 0.95). Similar results were observed in atrial fibrillation patients with liver disease and cirrhosis subgroups. Furthermore, the pooled estimates of the Child-Turcotte-Pugh (CTP) class indicated that DOACs reduced the incidence of all bleeding (RR: 0.61; 95%CI: 0.45 to 0.82), gastrointestinal bleeding (RR 0.55; 95%CI: 0.37 to 0.83), and all-cause death (RR: 0.62; 95%CI: 0.49 to 0.79) in patients with mild to moderate cirrhosis.

Conclusions: Our study demonstrates that DOACs significantly reduce the risk of bleeding in patients with liver disease compared with warfarin/LMWH.

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肝病患者直接口服抗凝剂的安全性:一项系统综述和荟萃分析

背景:直接口服抗凝剂(DOACs)，如阿哌沙班、依多沙班、利伐沙班或达比加群，是房颤(AF)和深静脉血栓栓塞的有效治疗方法。我们希望评估DOACs与华法林/低分子肝素(LMWH)在改善不同严重程度肝病患者出血事件方面的安全性。方法:我们系统地检索了Cochrane图书馆、PubMed和Embase数据库，以报告DOACs对肝硬化患者的影响。选择随机效应模型或固定效应模型汇总风险比(RR)和95%置信区间(CI)。结果:本荟萃分析共纳入18项研究，涉及41,447名参与者。与华法林/低分子肝素相比，DOACs的使用显著降低了所有出血的发生率(RR: 0.76;95%CI: 0.66 ~ 0.87)、大出血(RR: 0.51;95%CI: 0.28 ~ 0.91)、颅内出血(RR: 0.50;95%CI: 0.31 ~ 0.81)，胃肠道出血(RR: 0.76, 95%CI: 0.60 ~ 0.97)，以及肝病患者的全因死亡(RR: 0.77;95%CI: 0.62 ~ 0.95)。在伴有肝病和肝硬化的房颤患者亚组中也观察到类似的结果。此外，child - turcote - pugh (CTP)分类的汇总估计表明，DOACs降低了所有出血的发生率(RR: 0.61;95%CI: 0.45 ~ 0.82)，胃肠道出血(RR 0.55;95%CI: 0.37 ~ 0.83)和全因死亡(RR: 0.62;95%CI: 0.49 ~ 0.79)。结论:我们的研究表明，与华法林/低分子肝素相比，DOACs可显著降低肝病患者出血的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Clinica Belgica 医学-医学：内科

CiteScore

2.90

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.