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Evaluating Anticoagulation Strategies in Atrial Fibrillation with Liver Disease: A Meta-Analytical Comparison of Direct Oral Anticoagulants and Warfarin.

Mohamed S. Imam Fahad Saeed Algahtani Asim Abdullah Saleh Alqahtani Nawaf Mohammed Ali Naser Abdulaziz Ali Mohammed Asiri Shaimaa Mulfi Hussein Alqhtani Naif Ayidh Alshabab Bayan Sami Altalhi Shmookh Abdulrazak Abdurabuh Altalhi Norah S Alotaibi Amjad Homoud Masoud Alotaibi Saleh Abdulrahman Saleh Hunjur Rahaf Haif Ajlan Alshehri Yara Abdulaziz Alharthi Ouns Naif Mosa Muderba

Aug 2026 · Journal of Pioneering Medical Sciences · 0 citations

Abstract

Background: Anticoagulation is crucial for preventing stroke and Atrial Fibrillation (AF) is a significant risk factor for thromboembolism. However, because of changed medication metabolism and coagulation profiles, treating anticoagulation in patients with concurrent Liver Disease (LD) is difficult. The safety and effectiveness of direct oral anticoagulants (DOACs) and warfarin in patients with AF and LD are compared in this meta-analysis. Methods: A comprehensive literature search was implemented through January 2025. The study included ten observational studies that involved 417,754 patients with AF and LD. The outcomes that were evaluated included all-cause mortality, intracranial hemorrhage, stroke or systemic embolism, major bleeding and gastrointestinal bleeding. Random-effects models were employed to calculate pooled Odds Ratios (ORs) with 95% Confidence Intervals (CIs). The I² statistic was employed to evaluate heterogeneity. Results: DOACs were associated with substantially reduced risks of all-cause mortality (OR = 0.76, 95% CI: 0.58-0.99; p = 0.04), intracranial hemorrhage (OR = 0.48, 95% CI: 0.24-0.94; p = 0.03) and major bleeding (OR = 0.65, 95% CI: 0.49-0.87; p = 0.003) compared to warfarin. There were no significant differences observed in the incidence of stroke or systemic embolism (OR = 0.76, 95% CI: 0.56-1.02; p = 0.07) or gastrointestinal hemorrhage (OR = 0.97, 95% CI: 0.79-1.20; p = 0.81). Substantial heterogeneity was observed among outcomes (I²>90% in multiple analyses). Conclusion: It appears that DOACs provide comparable efficacy and enhanced safety in patients with AF and LD when compared to warfarin. Nevertheless, the observational design of the included studies and the substantial heterogeneity of the data necessitate caution in the interpretation of these results. Additional randomized controlled trials are required to verify these findings and inform clinical decision-making.

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