Abstract 4367135: Navigating the Anticoagulation Dilemma: The Impact of Anticoagulation Use on Outcomes and Healthcare Burden in Patients with Liver Cirrhosis and Co-Existing Atrial Fibrillation

Background: AF is a common comorbidity in patients with liver cirrhosis and may negatively impact both quality of life and prognosis. The management of AF in this population is complex due to cirrhosis-related disruptions in hemostasis, which increase the risk of both thrombosis and bleeding. These competing risks make decisions regarding anticoagulation therapy particularly challenging. This study aimed to evaluate the impact of anticoagulation on outcomes among patients with cirrhosis and coexisting AF. Research Question: Does anticoagulation use affect mortality, complications, or resource utilization in hospitalized patients with liver cirrhosis and atrial fibrillation? Methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) from 2016 to 2021. Adult patients hospitalized with liver cirrhosis were identified using ICD-10 diagnostic codes. Among these, individuals with coexisting AF were selected and categorized by current or long-term use of anticoagulation (AC). The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), ICU utilization, mesenteric ischemia, portal vein thrombosis, venous thromboembolism (deep vein thrombosis [DVT] and pulmonary embolism [PE]), acute myocardial infarction/angina (AMI), cardiac arrest, and bleeding complications (transfusion, gastrointestinal bleeding, intracranial hemorrhage). Multivariable regression analyses were performed adjusting for patient demographics, comorbidities, and hospital characteristics. Results: The study included 11,140 patients with cirrhosis and AF, of whom 2,417 (21.70%) received AC. AC use was associated with reduced in-hospital mortality (adjusted odds ratio [aOR] 0.75; 95% CI, 0.58–0.98; P=0.03), ICU admission (aOR 0.65; 95% CI, 0.50–0.84; P<0.01), AMI (aOR 0.71; 95% CI, 0.54–0.95; P=0.02), and GI bleeding (aOR 0.75; 95% CI, 0.62–0.90; P<0.01). No significant differences were found in LOS, THC, mesenteric ischemia, portal vein thrombosis, DVT/PE, cardiac arrest, transfusion, or intracranial hemorrhage. Conclusion: In hospitalized patients with cirrhosis and AF, AC therapy was associated with reduced mortality, ICU use, AMI, and GI bleeding, without increased risk of other major complications. These findings support the safety and benefit of AC in this population and underscore the need for individualized risk assessment rather than default avoidance due to cirrhosis