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Article: Association Between Nonvitamin K Antagonist Oral Anticoagulants or Warfarin and Liver Injury: A Cohort Study

TitleAssociation Between Nonvitamin K Antagonist Oral Anticoagulants or Warfarin and Liver Injury: A Cohort Study
Authors
Issue Date2020
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at https://journals.lww.com/ajg/pages/default.aspx
Citation
The American Journal of Gastroenterology, 2020, Epub 2020-05-27 How to Cite?
AbstractThe risk of liver injury in patients with atrial fibrillation (AF) using nonvitamin K antagonist oral anticoagulants (NOACs) has not been previously examined using liver function tests as the primary outcome in the real-world setting. This study assessed the association between NOACs (dabigatran, rivaroxaban, and apixaban) and warfarin and the risk of liver injury, as defined by laboratory tests. METHODS: Patients newly diagnosed with AF and prescribed NOACs or warfarin between 2010 and 2016, identified using the Hong Kong Clinical Database and Reporting System, were matched on age, sex, health status scores, comorbidities, and medications by propensity score on a 1:1 ratio. Risk of liver injury, defined as laboratory test values >3 times the upper limit of normal of alanine aminotransferase or aspartate aminotransferase and >2 times the upper limit of normal of total bilirubin, was compared between NOAC and warfarin users using Cox proportional hazards regression. RESULTS: After propensity score matching, 13,698 patients were included, of which 141 (2.1%) NOAC users and 232 (3.4%) warfarin users developed liver injury. The hazard ratio (HR) for NOAC vs warfarin users was 0.71 (95% confidence interval: 0.58–0.89). When comparing individual NOACs, only dabigatran (hazard ratio: 0.63; 95% confidence interval: 0.48–0.82) was associated with a lower risk of liver injury. DISCUSSION: Among patients with AF, NOACs as a group, and dabigatran alone were associated with a significantly lower risk of laboratory-based liver injury when compared with warfarin. However, liver injury occurs more frequently in real-world practice than in NOAC randomized controlled trials.
Persistent Identifierhttp://hdl.handle.net/10722/284569
ISSN
2019 Impact Factor: 10.171
2015 SCImago Journal Rankings: 3.946

 

DC FieldValueLanguage
dc.contributor.authorZhao, J-
dc.contributor.authorBLAIS, JE-
dc.contributor.authorChui, CSL-
dc.contributor.authorSuh, IH-
dc.contributor.authorChen, EYH-
dc.contributor.authorSeto, WK-
dc.contributor.authorMok, MT-
dc.contributor.authorYan, VKC-
dc.contributor.authorLau, WCY-
dc.contributor.authorWong, ICK-
dc.contributor.authorChan, EWL-
dc.date.accessioned2020-08-07T08:59:30Z-
dc.date.available2020-08-07T08:59:30Z-
dc.date.issued2020-
dc.identifier.citationThe American Journal of Gastroenterology, 2020, Epub 2020-05-27-
dc.identifier.issn0002-9270-
dc.identifier.urihttp://hdl.handle.net/10722/284569-
dc.description.abstractThe risk of liver injury in patients with atrial fibrillation (AF) using nonvitamin K antagonist oral anticoagulants (NOACs) has not been previously examined using liver function tests as the primary outcome in the real-world setting. This study assessed the association between NOACs (dabigatran, rivaroxaban, and apixaban) and warfarin and the risk of liver injury, as defined by laboratory tests. METHODS: Patients newly diagnosed with AF and prescribed NOACs or warfarin between 2010 and 2016, identified using the Hong Kong Clinical Database and Reporting System, were matched on age, sex, health status scores, comorbidities, and medications by propensity score on a 1:1 ratio. Risk of liver injury, defined as laboratory test values >3 times the upper limit of normal of alanine aminotransferase or aspartate aminotransferase and >2 times the upper limit of normal of total bilirubin, was compared between NOAC and warfarin users using Cox proportional hazards regression. RESULTS: After propensity score matching, 13,698 patients were included, of which 141 (2.1%) NOAC users and 232 (3.4%) warfarin users developed liver injury. The hazard ratio (HR) for NOAC vs warfarin users was 0.71 (95% confidence interval: 0.58–0.89). When comparing individual NOACs, only dabigatran (hazard ratio: 0.63; 95% confidence interval: 0.48–0.82) was associated with a lower risk of liver injury. DISCUSSION: Among patients with AF, NOACs as a group, and dabigatran alone were associated with a significantly lower risk of laboratory-based liver injury when compared with warfarin. However, liver injury occurs more frequently in real-world practice than in NOAC randomized controlled trials.-
dc.languageeng-
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at https://journals.lww.com/ajg/pages/default.aspx-
dc.relation.ispartofThe American Journal of Gastroenterology-
dc.rightsThis is a non-final version of an article published in final form in (provide complete journal citation)-
dc.titleAssociation Between Nonvitamin K Antagonist Oral Anticoagulants or Warfarin and Liver Injury: A Cohort Study-
dc.typeArticle-
dc.identifier.emailZhao, J: jxzhao@hku.hk-
dc.identifier.emailChui, CSL: cslchui@hku.hk-
dc.identifier.emailSeto, WK: wkseto@hku.hk-
dc.identifier.emailYan, VKC: kcyan96@hku.hk-
dc.identifier.emailLau, WCY: wallisy@hku.hk-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.emailChan, EWL: ewchan@hku.hk-
dc.identifier.authorityChui, CSL=rp02527-
dc.identifier.authoritySeto, WK=rp01659-
dc.identifier.authorityWong, ICK=rp01480-
dc.identifier.authorityChan, EWL=rp01587-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.14309/ajg.0000000000000678-
dc.identifier.scopuseid_2-s2.0-85090491840-
dc.identifier.hkuros311608-
dc.identifier.volumeEpub 2020-05-27-
dc.publisher.placeUnited States-

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