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Risk of Adverse Events in Anticoagulated Patients With Atrial Fibrillation and Nonalcoholic Fatty Liver Disease

Authors: Bucci, Tommaso; Nabrdalik, Katarzyna; Baratta, Francesco; Pastori, Daniele; Pignatelli, Pasquale; Hydes, Theresa; Alam, Uazman; +2 Authors

Risk of Adverse Events in Anticoagulated Patients With Atrial Fibrillation and Nonalcoholic Fatty Liver Disease

Abstract

Abstract Background The clinical impact of nonalcoholic fatty liver disease (NAFLD) in patients with atrial fibrillation (AF) is still controversial. Aim To evaluate the 1-year risk of all-cause death, thromboembolic events, and bleeding in patients with AF-NAFLD. Methods Retrospective study with a health research network (TriNetX). Patients with AF on oral anticoagulation (OAC) were categorized according to the presence of NAFLD into 2 groups. The primary outcomes were the 1-year risks of (1) a composite cardiovascular outcome (all-cause death, myocardial infarction, stroke, cardiac arrest, and pulmonary embolism) and (2) a composite hemorrhagic outcome (intracranial hemorrhage and gastrointestinal bleeding). Cox regression analysis before and after propensity score matching was used to estimate hazard ratio (HR) and 95% 95% CI,. Sensitivity analyses investigated the risk associated with cirrhosis, thrombocytopenia, and type of OAC (warfarin vs non-vitamin K antagonist oral anticoagulants (NOACs). Results We identified 22 636 patients with AF-NAFLD (69 ± 12 years, 46.7% females) and 391 014 patients with AF and without liver disease (72 ± 12 years, 42.7% females). NAFLD was associated with a higher risk of composite cardiovascular (HR, 1.54; 95% CI, 1.47-1.61) and hemorrhagic (HR, 1.56; 95% CI, 1.42-1.72) outcomes. This was consistent also for all the single outcomes. Cirrhotic and thrombocytopenic patients with AF-NAFLD showed the highest risks. Compared to patients with AF-NAFLD on NOACs, those on warfarin were associated with a higher risk of cardiovascular and hemorrhagic outcomes. Conclusion In patients with AF, NAFLD is associated with a higher 1-year risk of adverse events, with the risk of adverse events progressively increasing from noncirrhotic to cirrhotic and from nonthrombocytopenic to thrombocytopenic patients. NOACs were associated with a better effectiveness and safety profile compared to warfarin.

Keywords

Male, Administration, Oral, Thromboembolism/prevention & control, Hemorrhage, Warfarin/adverse effects, cardiovascular events, all-cause death, Non-alcoholic Fatty Liver Disease, Risk Factors, Hemorrhage/chemically induced, Thromboembolism, Atrial Fibrillation, Humans, atrial fibrillation, Retrospective Studies, Aged, Aged, 80 and over, Clinical Research Article, Non-alcoholic Fatty Liver Disease/complications, non-alcoholic fatty liver disease, Anticoagulants, Middle Aged, bleeding, Female, atrial fibrillation; all-cause death; bleeding; cardiovascular events; non-alcoholic fatty liver disease, Warfarin, Anticoagulants/adverse effects, Atrial Fibrillation/complications

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
5
Top 10%
Top 10%
Top 10%
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