PB0026 - Infrequent use of anticoagulant therapy for atrial fibrillation among patients with chronic liver disease

Background: The ISTH SSC on "Hemostatic Management of Patients with Liver Disease" has proposed guidance recommending anticoagulant therapy for chronic liver disease (CLD) patients with atrial fibrillation (AF) who have a CHA2DS2-VASc score > 1. In this study, we quantified use of anticoagulant therapy for AF in US Veterans with CLD as well as patient-specific variables associated with the decision to start anticoagulant therapy.

Aims: To evaluate initiation of anticoagulant therapy for patients with CLD presenting with newly diagnosed AF and CHADS2Vasc ≥ 2 and to delineate demographic and clinical factors influencing anticoagulant initiation.

Methods: We identified patients with CLD and incident diagnosis of AF in the Veterans Health Administration (2002-2019) using ICD 9/10 codes. We excluded Veterans who had an alternative indication (i.e., venous thromboembolism) or prior prescription for anticoagulant therapy. We stratified patients by CHADS2Vasc score and determined the number of patients with CHADS2Vasc ≥ 2 who received at least one anticoagulant prescription (for ≥ 30-days) within 30 days of AF diagnosis. Using multivariable logistic regression, we measured the association between baseline patient demographic and clinical factors association with initiation of therapy.

Results: We identified 1818 patients with CLD and incident AF of whom 1371 had a CHADS2Vasc score ≥ 2. Of these, 264 (19.3%) received an anticoagulant, 243 (17.7%) received antiplatelet drugs and 864 (63%) received no antithrombotic therapy.
In multivariable analysis, higher BMI (>30) increased the odds of anticoagulant initiation whereas severe CLD (MELD > 19), alcoholic CLD, and thrombocytopenia reduced the odds of anticoagulant initiation (Table 2).

Conclusion(s): This study of current practice patterns in US Veterans with CLD and incident AF found that < 20% of those with a CHADS2Vasc score of ≥ 2 received prescription for anticoagulant therapy. Patients with MELD score > 19, alcoholic CLD and thrombocytopenia were less likely to receive anticoagulant therapy.