SYSTEMATIC REVIEW
Efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and liver disease: an updated systematic review and meta-analysis
1
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
2
Department of Medicine, Khyber Medical College, Peshawar, Pakistan
3
Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
4
Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
5
Department of Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
6
Rawalpindi Medical University, Pakistan
7
Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
8
Sunderland Royal Hospital, UK
9
Imperial College London, UK
Submission date: 2025-02-15
Final revision date: 2025-05-12
Acceptance date: 2025-05-25
Publication date: 2025-05-30
Corresponding author
Arch Med Sci Atheroscler Dis 2025;10(1):78-88
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Although previous meta-analyses have explored the efficacy and safety of direct oral anticoagulants (DOAC) compared to warfarin in patients with atrial fibrillation (AFib) and liver disease, recent studies and emerging data necessitate a re-evaluation of the topic. Therefore, we conducted an updated meta-analysis to incorporate the latest evidence and provide a more comprehensive understanding of the literature. This meta-analysis aimed to assess the safety and efficacy of DOAC in patients diagnosed with AFib and liver disease.
Material and methods:
Following PRISMA guidelines, this meta-analysis is registered with PROSPERO (2024 CRD42024584964). A detailed search up to August 2024 was conducted for the studies comparing DOAC with warfarin. The quality of the included observational studies was evaluated using the Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) tool.
Results:
This meta-analysis included 53,224 participants with AFib and liver disease. The use of DOAC, in comparison to warfarin, was significantly linked to a lower risk of all-cause mortality (HR = 0.77; 95% CI: 0.60–0.98; p = 0.04) and a decreased occurrence of intracranial haemorrhage (HR = 0.49; 95% CI: 0.40–0.59; p < 0.00001). However, other outcomes did not demonstrate statistically significant differences.
Conclusions:
Recent studies indicate that DOAC are at least non-inferior to warfarin concerning efficacy and safety of patients with AFib and liver disease.
Although previous meta-analyses have explored the efficacy and safety of direct oral anticoagulants (DOAC) compared to warfarin in patients with atrial fibrillation (AFib) and liver disease, recent studies and emerging data necessitate a re-evaluation of the topic. Therefore, we conducted an updated meta-analysis to incorporate the latest evidence and provide a more comprehensive understanding of the literature. This meta-analysis aimed to assess the safety and efficacy of DOAC in patients diagnosed with AFib and liver disease.
Material and methods:
Following PRISMA guidelines, this meta-analysis is registered with PROSPERO (2024 CRD42024584964). A detailed search up to August 2024 was conducted for the studies comparing DOAC with warfarin. The quality of the included observational studies was evaluated using the Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) tool.
Results:
This meta-analysis included 53,224 participants with AFib and liver disease. The use of DOAC, in comparison to warfarin, was significantly linked to a lower risk of all-cause mortality (HR = 0.77; 95% CI: 0.60–0.98; p = 0.04) and a decreased occurrence of intracranial haemorrhage (HR = 0.49; 95% CI: 0.40–0.59; p < 0.00001). However, other outcomes did not demonstrate statistically significant differences.
Conclusions:
Recent studies indicate that DOAC are at least non-inferior to warfarin concerning efficacy and safety of patients with AFib and liver disease.
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