{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T12:24:42Z","timestamp":1791116682506,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["2U54GM104942\u201002"],"award-info":[{"award-number":["2U54GM104942\u201002"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anticoagulation (AC) is used for stroke prevention in atrial fibrillation (AF). Direct Oral Anticoagulants (DOACs) are safe in patients with AF without cirrhosis, they are hardly studied in patients with advanced cirrhosis. Our study evaluates the safety and outcomes of DOACs in patients with Child\u2010Pugh class C cirrhosis (CPC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We queried TriNetX Database. Patients with CPC and AF were divided into three cohorts: patients on DOACs, no AC, and warfarin. Three study arms were created using a 1:1 propensity score matching system (PSM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Totally 16\u2009029 patients met the inclusion criteria. Of those, 20.2% (<jats:italic>n<\/jats:italic>\u2009=\u20093235) were on DOACs, 47.1% (<jats:italic>n<\/jats:italic>\u2009=\u20097552) were not on AC, and 32.7% (<jats:italic>n<\/jats:italic>\u2009=\u20095242) were on warfarin. First arm comparing AC <jats:italic>versus<\/jats:italic> no AC, a statistically significant benefit was identified in 3\u2010year mortality risk (47% <jats:italic>vs<\/jats:italic> 71%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and transplant status (17% <jats:italic>vs<\/jats:italic> 5%, p\u2009&lt;\u20090.0001) with AC. However, no significant difference was identified regarding intracranial hemorrhage and GI bleeding risk. Second arm comparing patients on DOACs <jats:italic>versus<\/jats:italic> no AC, we identified mortality benefit (40% <jats:italic>vs<\/jats:italic> 72%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and a higher transplant rate (9% <jats:italic>vs<\/jats:italic> 3.2%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) with DOACs. Intracranial hemorrhage rates (6% <jats:italic>vs<\/jats:italic> 4%, <jats:italic>P<\/jats:italic>\u2009=\u20090.03) were higher in patients on DOACs. Third arm comparing patients on DOACs <jats:italic>versus<\/jats:italic> Warfarin, a statistically significant lower risk of intracranial hemorrhage (6.6% <jats:italic>vs<\/jats:italic> 8.7%, <jats:italic>P<\/jats:italic>\u2009=\u20090.004) and GI bleed (2% <jats:italic>vs<\/jats:italic> 2.4%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) were identified in patients on DOACs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Anticoagulation is safe in patients with CPC with AF and may provide a mortality benefit. DOACs are a safer alternative to warfarin.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.13074","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T03:05:01Z","timestamp":1714619101000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Safety of DOACs in patients with Child\u2010Pugh Class C cirrhosis and atrial fibrillation"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6518-3971","authenticated-orcid":false,"given":"Mark","family":"Ayoub","sequence":"first","affiliation":[{"name":"West Virginia University Charleston Division, Internal Medicine Department Charleston Area Medical Center  Charleston West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Faris","sequence":"additional","affiliation":[{"name":"Marshall University School of Medicine Surgery Department  Huntington West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julton Tomanguillo","family":"Chumbe","sequence":"additional","affiliation":[{"name":"West Virginia University Charleston Division, Internal Medicine Department Charleston Area Medical Center  Charleston West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebubekir","family":"Daglilar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Charleston Division West Virginia University School of Medicine, Charleston Area Medical Center  Charleston West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeem","family":"Anwar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Charleston Division West Virginia University School of Medicine, Charleston Area Medical Center  Charleston West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishnu","family":"Naravadi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Charleston Division West Virginia University School of Medicine, Charleston Area Medical Center  Charleston West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13459"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2018.12.001"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005307"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.1048"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000208"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.316340"},{"key":"e_1_2_6_8_1","unstructured":"Stats of the States\u2014Chronic Liver Disease\/Cirrhosis. 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