Dabigatran lowers risk of liver injury in AF patients

Use of nonvitamin K antagonist oral anticoagulants (NOACs), particularly dabigatran, is associated with a significantly reduced risk of laboratory-based liver injury among patients with atrial fibrillation (AF) when compared with warfarin, results of a recent study have shown.

“However, liver injury occurs more frequently in real-world practice than in NOAC randomized controlled trials,” the investigators noted.

This study examined the association between NOACs (dabigatran, rivaroxaban, and apixaban) and warfarin and the risk of liver injury, as defined by laboratory tests.

Patients newly diagnosed with AF and prescribed NOACs or warfarin between 2010 and 2016 were identified using the Hong Kong Clinical Database and Reporting System and were matched on age, sex, health status scores, comorbidities, and medications by propensity score on a 1:1 ratio.

Cox proportional hazards regression was used to compare between NOAC and warfarin users the 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.

A total of 13,698 patients were included after propensity score matching. Of these, 141 (2.1 percent) NOAC users and 232 (3.4 percent) warfarin users developed liver injury. Compared with warfarin users, those on NOAC had a hazard ratio (HR) of 0.71 (95 percent confidence interval [CI], 0.58–0.89).

Of note, comparisons of individual NOACs revealed that only dabigatran (HR, 0.63, 95 percent CI, 0.48–0.82) showed an association with a reduced risk of liver injury.