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July 18, 2026Clinical and Molecular HepatologyOpen Access

Oral anticoagulants and hepatic decompensation in patients with cirrhosis and atrial fibrillation: observational study

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Why the study?

Do oral anticoagulants reduce the risk of hepatic decompensation and major bleeding in patients with compensated cirrhosis and atrial fibrillation?

Population

1,160 patients with compensated cirrhosis and newly diagnosed atrial fibrillation, median age 73 years…

Comparison

Initiation of oral anticoagulants vs Non-initiation of oral anticoagulants

Design

Cohort

Follow-up

5 years

Key result

Initiation of oral anticoagulants in patients with compensated cirrhosis and atrial fibrillation reduced the 5-year risk of hepatic decompensation by 38% (RR 0.62) compared to non-initiators.

Authors

AWAxel WesterEGEmilie Toresson GripRRRupesh Rajani

Discussion

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Overview

Should not yet change practice in compensated cirrhosis with AF; leaves open need for randomized confirmation of decompensation benefit.

Key Points

  • This study estimates the effect of oral anticoagulants on hepatic decompensation and major bleeding risks in patients with compensated cirrhosis and atrial fibrillation.
  • Employed observational data from Swedish healthcare registers from 2011-2022.
  • Used inverse-probability weighted marginal structural models to compare risks of hepatic decompensation and major bleeding in initiators vs non-initiators of oral anticoagulants.
  • Included 1,160 patients with compensated cirrhosis and atrial fibrillation.
  • 5-year risk of hepatic decompensation was 10.4% in initiators vs 16.6% in non-initiators (RR=0.62, 95% CI=0.33-0.92).
  • Risk of major bleeding was similar between groups: 19.0% in initiators vs 19.8% in non-initiators (RR=0.96, 95% CI=0.64-1.28).
  • Number needed to treat for preventing one case of hepatic decompensation was 17 (95% CI=9-112).

Study Design

Type

Observational (n=1,160)

Structured PICO

Do oral anticoagulants reduce the risk of hepatic decompensation and major bleeding in patients with compensated cirrhosis and atrial fibrillation?

P
Population
1,160 adults with compensated cirrhosis and newly diagnosed atrial fibrillation, followed for up to 5 years.
E
Exposure
Initiation of oral anticoagulants
C
Comparator
Non-initiation of oral anticoagulants
O
Outcome
5-year risk of hepatic decompensation and non-portal hypertension-related major bleedinghard clinical

Main Result

Relative Risk: 0.62 (95% CI 0.33–0.92)

Absolute Event Rate: 10.4% vs 16.6%

Absolute Risk Reduction: 6.2%

Number Needed to Treat: 17

In patients with compensated cirrhosis and atrial fibrillation, initiating oral anticoagulants is associated with a reduced risk of hepatic decompensation without increasing the risk of major bleeding.

Limitations

  • Observational design with potential for residual confounding
  • Potential misclassification of cirrhosis or outcomes in register data

Cite This Study

Wester et al. (2026) conducted an observational in Compensated cirrhosis and atrial fibrillation (n=1,160). Oral anticoagulants vs. Non-initiators was evaluated on First hepatic decompensation during follow-up (RR 0.62, 95% CI 0.33-0.92). Initiation of oral anticoagulants in patients with compensated cirrhosis and atrial fibrillation reduced the 5-year risk of hepatic decompensation by 38% (RR 0.62) compared to non-initiators.

synapsesocial.com/papers/6a5b172618557b26c2039851https://doi.org/10.3350/cmh.2026.0286
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparative outcomes of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and liver cirrhosis: A propensity score matched TriNetX analysis2026
  2. 2Retrospective cohort study on long-term anticoagulation therapy for bleeding complications among atrial fibrillation patients2025
  3. 3Effectiveness and safety of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with liver disease: a systematic review and meta-analysis2025
  4. 4Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk2026
  5. 5Evaluation of the Use of Primary Prevention Aspirin in Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant for Stroke Prevention2025