DOACs reduce risk for new-onset portal hypertension in patients with cirrhosis and atrial fibrillation: A retrospective cohort study.

Anticoagulation therapy was associated with a significantly lower risk of new-onset portal hypertension in patients with cirrhosis and atrial fibrillation.

• Study population included 502 hospitalized patients with cirrhosis and AF at Beijing Ditan Hospital from 2010 to 2019.
• Among 502 patients, 50 received oral anticoagulation.
• The association was statistically significant (P < .001) in the full cohort.
• After propensity score matching (n = 233), the reduction in portal hypertension remained significant (P < .026).

Anticoagulation therapy was associated with a significantly lower risk of gastrointestinal bleeding without increasing mortality.

• Gastrointestinal bleeding was reduced in the anticoagulation group in the full cohort (P < .005).
• After propensity score matching, the reduction in gastrointestinal bleeding remained significant (P < .025).
• All-cause mortality was not significantly increased with anticoagulation in the full cohort (P < .003) or after propensity score matching.
• Kaplan-Meier analysis confirmed improved survival in the anticoagulation group (P < .002).

Propensity score matching was used to minimize confounding between anticoagulated and non-anticoagulated patients.

• The matched cohort included 233 patients after propensity score matching.
• Clinical data, risk scores, and liver severity indices including Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were collected and used in the analysis.
• The study design was retrospective, conducted at a single center (Beijing Ditan Hospital).

Direct oral anticoagulants (DOACs) were specifically identified as the anticoagulant class associated with reduced risk for new-onset portal hypertension.

• Among the 50 patients who received oral anticoagulation, DOACs were highlighted as the agent of interest.
• The study evaluated primary endpoints of new-onset portal hypertension and all-cause mortality, and secondary endpoints of gastrointestinal bleeding and thromboembolic events.
• The authors noted that the role of DOACs in the cirrhosis and AF population remains uncertain and that prospective studies are warranted to confirm these findings.

Patients with liver cirrhosis and atrial fibrillation represent a therapeutic challenge due to conflicting risks of thrombosis and bleeding.

• The study population had both cirrhosis and AF, conditions that simultaneously elevate bleeding and thromboembolic risk.
• Only 50 of 502 patients (approximately 10%) received oral anticoagulation, suggesting underuse in this population.
• The study period spanned 2010 to 2019, reflecting real-world clinical practice over a decade.