Abstract
BACKGROUND: This meta-analysis aimed to compare the efficacy and safety of direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in patients with concomitant atrial fibrillation (AF) and liver cirrhosis (LC). METHODS: PubMed, Cochrane Library, Embase, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI) databases were searched for randomized clinical trials (RCTs) and non-RCTs comparing DOACs and VKAs in patients with AF and LC. Analyses were performed in R software. A random-effects model was employed to calculate the pooled hazard ratio (HR). RESULTS: Eleven studies encompassing 19,617 patients were included, with 9379 receiving DOACs and 10,238 receiving VKAs. DOACs were associated with a significant reduction in the incidence of major bleeding (HR 0.70; 95% CI: 0.61-0.81; P < 0.001; I(2) = 0%), all-cause mortality (HR 0.87; 95% CI: 0.78-0.98; P = 0.022; I(2) = 41%), and gastrointestinal bleeding (HR 0.75; 95% CI: 0.67-0.84; P < 0.001; I(2) = 4%). No significant difference was observed for thromboembolic events (HR 0.86; 95% CI: 0.69-1.06; P = 0.153; I(2) = 0%). CONCLUSION: DOACs may be a feasible option for patients with AF and LC, demonstrating similar effectiveness to VKAs while exhibiting a better safety profile. These findings await validation by prospective studies.