{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T06:19:35Z","timestamp":1782886775138,"version":"3.54.5"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"FI1","license":[{"start":{"date-parts":[[2020,3,4]],"date-time":"2020-03-04T00:00:00Z","timestamp":1583280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Region Health Ministry of the Lombardy Region"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims\u2003<\/jats:title>\n                  <jats:p>Data on the impact of liver disease (LD) in patients with atrial fibrillation (AF) and the role of oral anticoagulant (OAC) drugs for stroke prevention are limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results\u2003<\/jats:title>\n                  <jats:p>A retrospective observational population-based cohort study on the administrative health databases of Lombardy region Italy. All AF patients \u226540\u2009years admitted to hospital from 2000 to 2018 were considered. Atrial fibrillation and LD diagnosis were established using ICD9-CM codes. Use of OAC was determined with Anatomical Therapeutic Chemical codes. Primary study outcomes were stroke, major bleeding, and all-cause death. Among 393\u2009507 AF patients, 16\u2009168 (4.1%) had concomitant LD. Liver disease AF patients were significantly less treated with OAC. Concomitant LD was associated with an increased risk in all the study outcomes [hazard ratio (HR): 1.18, 95% confidence interval (CI): 1.11\u20131.25 for stroke; HR: 1.57, 95% CI: 1.47\u20131.66 for major bleeding; HR: 1.41, 95% CI: 1.39\u20131.44 for all-cause death]. Use of OAC in patients with AF and LD resulted in a reduction in stroke (HR: 0.80, 95% CI: 0.70\u20130.92), major bleeding (HR: 0.86, 95% CI: 0.74\u20130.99), and all-cause death (HR: 0.77, 95% CI: 0.73\u20130.80), with similar results according to subgroups. A net clinical benefit (NCB) analysis suggested a positive benefit\/risk ratio in using OAC in AF patients with LD (NCB: 0.408, 95% CI: 0.375\u20130.472).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In AF patients, concomitant LD carries a significantly higher risk for all clinical outcomes. Use of OAC in AF patients with LD was associated with a significant favourable\u00a0benefit\/risk ratio, even in high-risk patient subgroups.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvaa015","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T13:23:33Z","timestamp":1582896213000},"page":"f84-f92","source":"Crossref","is-referenced-by-count":11,"title":["Impact of liver disease on oral anticoagulant prescription and major adverse events in patients with atrial fibrillation: analysis from a population-based cohort study"],"prefix":"10.1093","volume":"7","author":[{"given":"Marco","family":"Proietti","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy"},{"name":"Geriatric Unit, Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7952-8278","authenticated-orcid":false,"given":"Irene","family":"Marzona","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Vannini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluca","family":"Colacioppo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Tettamanti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreana","family":"Foresta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida","family":"Fortino","sequence":"additional","affiliation":[{"name":"Regional Health Ministry, Lombardy Region, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Merlino","sequence":"additional","affiliation":[{"name":"Regional Health Ministry, Lombardy Region, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK"},{"name":"Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carla","family":"Roncaglioni","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,4]]},"reference":[{"key":"2021040921531129000_pvaa015-B1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1056\/NEJMra1011170","article-title":"The coagulopathy of chronic liver disease","volume":"365","author":"Tripodi","year":"2011","journal-title":"N Engl J 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