{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T06:58:01Z","timestamp":1789109881767,"version":"build-2803163510"},"reference-count":66,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Doctoral Research Initiation Fund of Jiangxi University of Technology"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Appl Thromb Hemost"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Currently, there is limited evidence regarding the use of direct oral anticoagulants (DOACs) for patients with liver cirrhosis (LC). We performed a meta-analysis to compare the efficacy and safety of DOACs versus warfarin in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Cochrane Library, Web of Science, Embase and Scopus databases from inception to August 2024. Clinical studies comparing the use of DOACs with warfarin in cirrhotic patients were included. Hazard ratios (HRs) with 95% CIs were estimated by either fixed or random effects models. Primary efficacy outcomes were ischemic stroke\/thromboembolism (IS\/TE) and all-cause death, the primary safety outcomes were the bleeding risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen studies were included (16\u2005829 individuals). DOACs had similar benefits in preventing IS\/TE (HR\u2009=\u20090.87, 95% CI: 0.69-1.10), but DOACs were significantly associated with reduced risk of all-cause death (HR\u2009=\u20090.87, 95% CI: 0.79-0.97). On the other hand, we observed significantly reduced risks of any bleeding (HR\u2009=\u20090.60; 95%CI: 0.37-0.95), major bleeding (HR\u2009=\u20090.72; 95%CI: 0.63-0.82), intracranial hemorrhage (ICH) (HR\u2009=\u20090.47; 95%CI: 0.30-0.73), and gastrointestinal bleeding (GIB) (HR\u2009=\u20090.72, 95% CI: 0.60-0.87) in patients receiving DOACs. Results were consistent in cirrhotic patients with AF. Furthermore, DOACs reduced the incidence of major bleeding (HR\u2009=\u20090.65, 95%CI: 0.55-0.78) and ICH (HR\u2009=\u20090.17, 95%CI: 0.04-0.76) in patients with moderate to severe cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study demonstrates that DOACs, compared with warfarin, exerted comparable efficacy and better safety and may represent a safer alternative to warfarin in cirrhotic patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10760296241301402","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T03:36:46Z","timestamp":1731901006000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Comparison of the Efficacy and Safety of  Direct Oral Anticoagulants and Warfarin  in Cirrhotic Patients: A Systematic Review  and Meta-Analysis"],"prefix":"10.1177","volume":"30","author":[{"given":"Chunwei","family":"Cheng","sequence":"first","affiliation":[{"name":"School of Medicine, Jiangxi University of Technology, Nanchang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-4317","authenticated-orcid":false,"given":"Liang","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"key":"bibr1-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.498"},{"key":"bibr2-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.03.070"},{"key":"bibr3-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-020-02526-6"},{"key":"bibr4-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.08.045"},{"key":"bibr5-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-02-261891"},{"key":"bibr6-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2024.101116"},{"key":"bibr7-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005307"},{"key":"bibr8-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.06.876"},{"key":"bibr9-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000001011"},{"key":"bibr10-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2015.27"},{"issue":"11","key":"bibr11-10760296241301402","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1055\/s-0032-1313182","volume":"50","author":"Gundling F","year":"2012","journal-title":"Z Gastroenterol"},{"key":"bibr12-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31264"},{"key":"bibr13-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.052"},{"key":"bibr14-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000001315"},{"key":"bibr15-10760296241301402","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v7.i27.2774"},{"key":"bibr16-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.07.018"},{"key":"bibr17-10760296241301402","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2021.0109"},{"key":"bibr18-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62343-0"},{"key":"bibr19-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.11.026"},{"key":"bibr20-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.01.011"},{"key":"bibr21-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1113572"},{"key":"bibr22-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019001881"},{"key":"bibr23-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2024.03.024"},{"key":"bibr24-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpth.2023.102293"},{"issue":"2","key":"bibr25-10760296241301402","volume":"59","author":"Costache RS","year":"2023","journal-title":"Medicina (Kaunas)"},{"key":"bibr26-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009263"},{"key":"bibr27-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2021.07.006"},{"key":"bibr28-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.061"},{"key":"bibr29-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2018.12.001"},{"key":"bibr30-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-019-00369-x"},{"key":"bibr31-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2018.08.011"},{"key":"bibr32-10760296241301402","volume":"372","author":"Page MJ","year":"2021","journal-title":"Br Med J."},{"issue":"1","key":"bibr33-10760296241301402","volume":"23","author":"Stratakis N","year":"2022","journal-title":"Obes Rev"},{"key":"bibr34-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.12895"},{"key":"bibr35-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.01.097"},{"key":"bibr36-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13045"},{"key":"bibr37-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011112"},{"key":"bibr38-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-019-02035-0"},{"issue":"10","key":"bibr39-10760296241301402","first-page":"479","volume":"37","author":"Jones K","year":"2020","journal-title":"Fed Pract"},{"key":"bibr40-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1177\/10600280211025050"},{"key":"bibr41-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1177\/10600280211047433"},{"key":"bibr42-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15046"},{"issue":"1563","key":"bibr43-10760296241301402","first-page":"52","volume":"135","author":"Munevar Aquite O","year":"2022","journal-title":"N Z Med J"},{"key":"bibr44-10760296241301402","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2020.622"},{"key":"bibr45-10760296241301402","doi-asserted-by":"publisher","DOI":"10.7326\/M23-3067"},{"key":"bibr46-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.060687"},{"key":"bibr47-10760296241301402","doi-asserted-by":"publisher","DOI":"10.15761\/JTS.1000182"},{"key":"bibr48-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2019.01.006"},{"key":"bibr49-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz405"},{"key":"bibr50-10760296241301402","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2019.00017"},{"key":"bibr51-10760296241301402","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S152109"},{"key":"bibr52-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcz127"},{"key":"bibr53-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-021-02424-4"},{"key":"bibr54-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1513"},{"key":"bibr55-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1080\/17843286.2022.2108259"},{"key":"bibr56-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0b013e328365d415"},{"key":"bibr57-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.05.020"},{"key":"bibr58-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1097\/FJC.0000000000000513"},{"key":"bibr59-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026863"},{"key":"bibr60-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-023-00598-1"},{"key":"bibr61-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-021-00482-w"},{"key":"bibr62-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12054"},{"key":"bibr63-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa945"},{"key":"bibr64-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12844"},{"issue":"4","key":"bibr65-10760296241301402","volume":"14","author":"Jarboe L","year":"2022","journal-title":"Cureus"},{"key":"bibr66-10760296241301402","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.13074"}],"container-title":["Clinical and Applied Thrombosis\/Hemostasis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10760296241301402","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10760296241301402","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10760296241301402","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:04:50Z","timestamp":1777385090000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10760296241301402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":66,"alternative-id":["10.1177\/10760296241301402"],"URL":"https:\/\/doi.org\/10.1177\/10760296241301402","relation":{},"ISSN":["1076-0296","1938-2723"],"issn-type":[{"value":"1076-0296","type":"print"},{"value":"1938-2723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"article-number":"10760296241301402"}}