Ronpichai ChokesuwattanaskulCharat ThongprayoonTarun BathiniAldo Torres-OrtizOisin A. O'CorragainKanramon WatthanasuntornPloypin LertjitbanjongKonika SharmaSomchai PreechawatPatompong UngprasertPaul T. KrönerKarn WijarnpreechaWisit CheungpasitpornKing Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn UniversityTemple University HospitalFaculty of Medicine, Siriraj Hospital, Mahidol UniversityUniversity of ArizonaMayo ClinicUniversity of Mississippi Medical CenterMayo Clinic in Jacksonville, FloridaBassett Medical Center2020-01-272020-01-272019-04-01Digestive and Liver Disease. Vol.51, No.4 (2019), 489-49518783562159086582-s2.0-85059016897https://repository.li.mahidol.ac.th/handle/20.500.14594/51779© 2018 Editrice Gastroenterologica Italiana S.r.l. Objective: The atrial fibrillation-related stroke is clearly prevented by anticoagulation treatment, however, management of anticoagulation for AF in patients with cirrhosis represents a challenge due to bleeding concerns. To address this issue, a systematic review and meta-analysis of the literature was performed. Methods: A literature search for studies reporting the incidence of AF in patients with cirrhosis was conducted using MEDLINE, EMBASE and Cochrane Database, from inception through July 2018. Results: 7 cohort studies including 19,798 patients with AF and cirrhosis were identified. The use of anticoagulation (%) among included studies ranged from 8.3% to 53.9%. Anticoagulation use for AF in patients with cirrhosis was significantly associated with a reduced risk of stroke, with a pooled HR of 0.58 (95%CI: 0.35–0.96). When compared with no anticoagulation, the use of anticoagulation was not significantly associated with a higher risk of bleeding, with a pooled HR of 1.45 (95%CI: 0.96–2.17). Compared to warfarin, the use of direct oral anticoagulants (DOACs) was associated with a lower risk of bleeding among AF patients with cirrhosis. Conclusion: Our study demonstrates that anticoagulation use for AF in patients with cirrhosis is associated with a reduced risk of stroke, without increasing significantly the risk of bleeding, when compared to those without anticoagulation.Mahidol UniversityMedicineReviewSCOPUS10.1016/j.dld.2018.12.001