Risks Versus Benefits of Anticoagulation for Atrial Fibrillation in Cirrhotic Patients

Background & Aims: To evaluate the clinical benefits and risks of anticoagulation with warfarin in cirrhotic patients with atrial fibrillation (AF). Methods: A total of 465 cirrhotic patients diagnosed with nonvalvular AF were retrospectively analyzed. We compared incidences of ischemic stroke and major bleeding events between the 2 groups and examined the factors predicting ischemic stroke or major bleeding events. Results: Of 465 patients with AF, 113 (24.3%) received warfarin. Warfarin users had a lower mean Child-Pugh score (6.1 +/- 1.5 vs. 7.6 +/- 2.6) and a higher mean CHA(2)DS(2)VASc score (2.0 +/- 2.5 vs. 1.7 +/- 1.3) than nonusers (P's < 0.05). Overall, the incidence of ischemic stroke was low in cirrhotic patients with AF. It was not dependent on the CHA(2)DS(2)VASc score (hazard ratio, 1.40; 95% confidence interval, 0.96-2.05; P = 0.081), and was comparable in warfarin users (0.9%/ person-year) and nonusers (1.2%/person-year). However, the incidence of major bleeding events was significantly higher in warfarin users (5.9% vs. 2.6%; P < 0.05). A multivariate analysis identified warfarin use (2.60; 95% confidence interval, 1.32-5.12) and Child-Pugh score (1.25; 1.04-1.49) as independently associated with bleeding events in these cirrhotic patients (P's < 0.05). There was no correlation between HAS-BLED score and risk of major bleeding (1.20; 0.95-1.52; P = 0.123). Conclusions: Anticoagulation with warfarin in cirrhotic patients with AF may not significantly reduce the risk of ischemic stroke, whereas it increases hemorrhagic complications.