DOACs associated with lower risk of liver injury hospitalisation compared to warfarin
Prospective study of oral anticoagulants and risk of liver injury in patients with atrial fibrillationLiterature - Alonso A, MacLehose RF, Chen LY et al. - Heart. 2017 Jan 5, doi:10.1136/heartjnl-2016-310586
- 960 hospitalisations with liver injury were reported during a median follow-up of 12 months. This equalizes to 7.3 events per 1000 person-years (95% CI 6.8-7.8).
- Cumulative risk of liver injury was highest in warfarin patients and lowest in dabigatran patients; corrected for age and sex this was 55%, 26% and 44% lower in dabigatran, rivaroxaban and apixaban patients compared to warfarin, respectively, which was similar although weaker when correcting for more factors.
- These associations were similar among all subgroups, although apixaban was associated with reduced risk of liver disease hospitalisation in men but not in women, compared to warfarin (P interaction = 0.03).
- Compared to dabigatran, rivaroxaban users had an increased risk of liver injury (HR 1.56, 95% CI: 1.22-1.99).
- Variables associated with the risk of liver injury hospitalisation (predictors) were liver disease, gallbladder disease, excessive alcohol consumption, kidney disease, cancer, anaemia, heart failure and type of oral anticoagulant.
- An excel-based calculator that provides the 1-year risk estimates of liver injury hospitalisation for each oral anticoagulant is available in the online supplement.
Although literature describes isolated case reports of hepatotoxicity linked to DOACs, the risk of liver injury hospitalisation among patients starting DOACs was lower than those starting warfarin. Among DOACs, risk was highest for rivaroxaban users compared with dabigatran and apixaban users. Moreover, several patient characteristics were predictive for liver injury hospitalisation which were used in an excel-based calculator that can help clinicians deciding between anticoagulants.