The safety and efficacy of vitamin K antagonist in patients with atrial fibrillation and liver cirrhosis

Seung Jun Lee, Jae Sun Uhm, Jong Youn Kim, huinam pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Bleeding is a major concern in treatment of atrial fibrillation (AF) with vitamin K antagonist (VKA). This concern is more emphasized in patients with high bleeding risk such as liver cirrhosis (LC). Methods and results We retrospectively analyzed incidence of stroke and major bleeding in 321 AF patients with LC, including early [Child-Pugh (CP)-A, n = 215] and advanced [CP-B or C, n = 106] LC according to VKA prescription. The CHA 2 DS 2 -VASc, HAS-BLED and MELD scores were higher in patients with VKA. CP score was positively correlated with HAS-BLED score (rho: 0.602). The incidence of major bleeding was higher in advanced LC than in early LC (14.5%/year vs. 4.9%/year, p < 0.001). VKA reduced the risk of ischemic stroke in AF patients with LC, whereas it significantly increased the major bleeding risk. There was no difference in survival free from significant clinical events (SCEs) between the patients with or without VKA (p = 0.91). On subgroup analysis, VKA was beneficial in early LC patients, as it decreased stroke without increasing major bleeding risk. However, in advanced LC patients, VKA significantly increased the risk of major bleeding, especially variceal origin, that overwhelms stroke reduction. As a result, VKA treatment reduced the risk of SCEs in early LC patients, whereas it increased the risk of SCEs in advanced LC. Conclusions VKA treatment might be beneficial to reduce significant clinical events in the early LC but not in the advanced LC group. However to confirm this hypothesis, a prospective randomized study is needed.

Original languageEnglish
Pages (from-to)185-191
Number of pages7
JournalInternational Journal of Cardiology
Volume180
DOIs
Publication statusPublished - 2015 Feb 1

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Vitamin K
Liver Cirrhosis
Atrial Fibrillation
Safety
Hemorrhage
Stroke
Incidence
Prescriptions
Therapeutics
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{a08d3002eb174e9f83fb06cc854b5aad,
title = "The safety and efficacy of vitamin K antagonist in patients with atrial fibrillation and liver cirrhosis",
abstract = "Background Bleeding is a major concern in treatment of atrial fibrillation (AF) with vitamin K antagonist (VKA). This concern is more emphasized in patients with high bleeding risk such as liver cirrhosis (LC). Methods and results We retrospectively analyzed incidence of stroke and major bleeding in 321 AF patients with LC, including early [Child-Pugh (CP)-A, n = 215] and advanced [CP-B or C, n = 106] LC according to VKA prescription. The CHA 2 DS 2 -VASc, HAS-BLED and MELD scores were higher in patients with VKA. CP score was positively correlated with HAS-BLED score (rho: 0.602). The incidence of major bleeding was higher in advanced LC than in early LC (14.5{\%}/year vs. 4.9{\%}/year, p < 0.001). VKA reduced the risk of ischemic stroke in AF patients with LC, whereas it significantly increased the major bleeding risk. There was no difference in survival free from significant clinical events (SCEs) between the patients with or without VKA (p = 0.91). On subgroup analysis, VKA was beneficial in early LC patients, as it decreased stroke without increasing major bleeding risk. However, in advanced LC patients, VKA significantly increased the risk of major bleeding, especially variceal origin, that overwhelms stroke reduction. As a result, VKA treatment reduced the risk of SCEs in early LC patients, whereas it increased the risk of SCEs in advanced LC. Conclusions VKA treatment might be beneficial to reduce significant clinical events in the early LC but not in the advanced LC group. However to confirm this hypothesis, a prospective randomized study is needed.",
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The safety and efficacy of vitamin K antagonist in patients with atrial fibrillation and liver cirrhosis. / Lee, Seung Jun; Uhm, Jae Sun; Kim, Jong Youn; pak, huinam; Lee, Moon Hyoung; Joung, Boyoung.

In: International Journal of Cardiology, Vol. 180, 01.02.2015, p. 185-191.

Research output: Contribution to journalArticle

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T1 - The safety and efficacy of vitamin K antagonist in patients with atrial fibrillation and liver cirrhosis

AU - Lee, Seung Jun

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - pak, huinam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background Bleeding is a major concern in treatment of atrial fibrillation (AF) with vitamin K antagonist (VKA). This concern is more emphasized in patients with high bleeding risk such as liver cirrhosis (LC). Methods and results We retrospectively analyzed incidence of stroke and major bleeding in 321 AF patients with LC, including early [Child-Pugh (CP)-A, n = 215] and advanced [CP-B or C, n = 106] LC according to VKA prescription. The CHA 2 DS 2 -VASc, HAS-BLED and MELD scores were higher in patients with VKA. CP score was positively correlated with HAS-BLED score (rho: 0.602). The incidence of major bleeding was higher in advanced LC than in early LC (14.5%/year vs. 4.9%/year, p < 0.001). VKA reduced the risk of ischemic stroke in AF patients with LC, whereas it significantly increased the major bleeding risk. There was no difference in survival free from significant clinical events (SCEs) between the patients with or without VKA (p = 0.91). On subgroup analysis, VKA was beneficial in early LC patients, as it decreased stroke without increasing major bleeding risk. However, in advanced LC patients, VKA significantly increased the risk of major bleeding, especially variceal origin, that overwhelms stroke reduction. As a result, VKA treatment reduced the risk of SCEs in early LC patients, whereas it increased the risk of SCEs in advanced LC. Conclusions VKA treatment might be beneficial to reduce significant clinical events in the early LC but not in the advanced LC group. However to confirm this hypothesis, a prospective randomized study is needed.

AB - Background Bleeding is a major concern in treatment of atrial fibrillation (AF) with vitamin K antagonist (VKA). This concern is more emphasized in patients with high bleeding risk such as liver cirrhosis (LC). Methods and results We retrospectively analyzed incidence of stroke and major bleeding in 321 AF patients with LC, including early [Child-Pugh (CP)-A, n = 215] and advanced [CP-B or C, n = 106] LC according to VKA prescription. The CHA 2 DS 2 -VASc, HAS-BLED and MELD scores were higher in patients with VKA. CP score was positively correlated with HAS-BLED score (rho: 0.602). The incidence of major bleeding was higher in advanced LC than in early LC (14.5%/year vs. 4.9%/year, p < 0.001). VKA reduced the risk of ischemic stroke in AF patients with LC, whereas it significantly increased the major bleeding risk. There was no difference in survival free from significant clinical events (SCEs) between the patients with or without VKA (p = 0.91). On subgroup analysis, VKA was beneficial in early LC patients, as it decreased stroke without increasing major bleeding risk. However, in advanced LC patients, VKA significantly increased the risk of major bleeding, especially variceal origin, that overwhelms stroke reduction. As a result, VKA treatment reduced the risk of SCEs in early LC patients, whereas it increased the risk of SCEs in advanced LC. Conclusions VKA treatment might be beneficial to reduce significant clinical events in the early LC but not in the advanced LC group. However to confirm this hypothesis, a prospective randomized study is needed.

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DO - 10.1016/j.ijcard.2014.11.183

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