10 Rates of Anticoagulation in Cirrhotic Atrial Fibrillation Patients

Historically, patients with cirrhotic liver disease had been considered as anticoagulated due to prolonged prothrombin (PT) and activated partial thromboplastin (aPTT) times. However, more current data describe cirrhotic patients as being in hemostatic balance as a result of destruction of pro- and anti-coagulant influences which then leads to both bleeding and thrombotic events in these patients. Furthermore, cirrhotic patients are at an increased risk for developing atrial fibrillation (AF). Evidence of anticoagulant benefit for cirrhotic patients with AF is limited due to consistent exclusion from clinical trials due to bleeding concerns; however, the American Gastroenterological Association Institute guidelines recommend anticoagulation over no anticoagulation due to point estimates that suggest improved mortality and decreased nonfatal stroke risk, in particular in cirrhotic patients with higher CHA2DS2-VASC scores.