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Aug 01, 2019

New Drugs Offer Better Treatment Options for Patients with AFib and Liver Disease

Study confirms safety and efficacy of new drugs in liver patients with an abnormal heart rhythm.

While liver disease can complicate the treatment of heart conditions, a new study confirms that novel anti-clotting drugs are both safe and effective in liver patients with an abnormal heart rhythm. Findings were published in the Journal of the American College of Cardiology and could expand treatment options for patients with atrial fibrillation.

Atrial fibrillation, often referred to as AFib, is the most common type of abnormal heart rhythm that affects as many as 6.1 million Americans. It occurs when the heart beats too fast, too slow or abnormally, and drastically increases risk for stroke—the leading cause of disability in the United States.

The recent study, which analyzed a Korean health insurance database, looked at which blood thinners work best in patients with both AFib and liver disease. It compared warfarin—a tried and true blood thinner that has been around since the 1950s—with a newer class of drugs called DOACs.

DOACs, short for direct oral anticoagulants, work to prevent blood clots and reduce risk of stroke. They’re generally recommended over warfarin because they’re easier to take and require less monitoring. However, few studies have tested DOACs in patients with liver disease, given their high risk of complications.

The recent study included data from more than 37,000 Korean patients treated for liver disease and AFib between 2013 and 2016. Among participants, about one-third took warfarin to prevent blood clots, while the other half took DOACs.

After more than a year of follow-up, researchers found that DOACs cut stroke risk in half compared to warfarin. Patients taking DOACs also had 35% lower risk of major bleeding and lower risk of death than those taking warfarin.

Types of DOACs included rivaroxaban, dabigatran, apixaban, and edoxaban—all of which are approved for the treatment of atrial fibrillation.

According to authors, findings support the use of DOACs in patients with AFib and liver disease. This is the first study of its kind to compare blood thinner use among patients with AFib and liver disease. And findings suggest that DOACs are preferable to warfarin, given their safety and efficacy in this population.

However, it’s important to note that the study was a real-world analysis of blood thinner use, rather than a clinical trial. Therefore, additional studies are likely needed to confirm findings before guidelines will be changed for patients with AFib and liver disease.

Questions for You to Consider

  • What is atrial fibrillation?

  • Atrial fibrillation is an irregular heart rhythm caused by abnormal, chaotic electrical impulses in the heart’s upper chambers, the atria. These electrical impulses, which interfere with the heart’s natural pacemaker, fire so rapidly the atria cannot beat with a regular rhythm or squeeze out blood effectively. Instead, they merely quiver while the ventricles, the heart’s lower chambers, beat rapidly.
  • How is atrial fibrillation treated?
  • In general, the goals of atrial fibrillation treatment are to promote a regular heart rhythm or rate and prevent blood clots, which can cause stroke. However, treatment strategies depend on the unique needs of each patient. Treatment options may include antiarrhythmic medication, blood thinners, and a variety of procedures that can help control atrial fibrillation.

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Infographic: Blood Thinners

Infographic: AFib