Abstract

not-yet-known not-yet-known not-yet-known unknown Aims: Patients with liver disease, particularly cirrhosis, are often excluded from clinical trials on anticoagulant therapy, therefore, the optimal choice of anticoagulants for this population is still unclear. Methods: We searched the databases of PubMed, the Cochrane Library, Medline, and Embase for relevant studies. Results: In this meta-analysis, we included 19 studies with 51,728 participants. In patients with liver disease, compared with that in the traditional group, the DOAC group showed a significantly lower risk for major bleeding, intracranial bleeding (ICH), gastrointestinal bleeding and composite outcome. We did not observe statistically significant differences between the groups with respect to ischemic stroke/thromboembolism (IS/TE), all-cause mortality. In patients with liver cirrhosis, the DOAC group performed better than the traditional group in terms of major bleeding, gastrointestinal bleeding, ICH, IS/TE + major bleeding and composite outcome. The efficacy and safety of regular-dose and low-dose DOACs showed no difference (P>0.05), whereas the efficacy and safety of apixaban were superior to those of rivaroxaban (P<0.05). Conclusion: The effectiveness of DOACs for anticoagulation treatment in patients with liver disease was not inferior to that of traditional anticoagulation regimens, and the safety of DOACs was better. The results were also applicable to patients with cirrhosis. When selecting among DOACs, apixaban demonstrated superior efficacy and safety compared to rivaroxaban. Furthermore, the clinical benefits observed between regular-dose and low-dose DOACs showed no significant difference.