Risk of death, thrombotic, and hemorrhagic events in anticoagulated patients with atrial fibrillation and hepatocellular carcinoma: An analysis from a global federated dataset.

Abstract

e16250 Background: Atrial fibrillation (AF) is a prevalent arrhythmia associated with increased thrombotic and hemorrhagic risks, necessitating anticoagulation therapy. Hepatocellular carcinoma (HCC) poses unique challenges due to coagulopathy and portal hypertension. However, the impact of HCC on anticoagulated AF patients remains limited. This study evaluated the risks of all-cause mortality, thrombotic, and hemorrhagic events in AF patients with and without HCC. Methods: This retrospective cohort study used the TriNetX global research network, focusing on the US Collaborative Network of 68 healthcare organizations. Anticoagulated AF patients were categorized by HCC status. Cohort 1 (AF + HCC) included 13,087 patients, while Cohort 2 (AF without HCC) included 13,087 propensity-matched patients. Outcomes included risks of (1) all-cause mortality, (2) thrombotic events (ischemic stroke, myocardial infarction (AMI), deep vein thrombosis, pulmonary embolism, and portal vein thrombosis (PVT)), and (3) hemorrhagic events (intracranial hemorrhage (ICH) and gastrointestinal bleeding (GIB)). Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Results: After matching, AF patients with HCC had higher risks of all-cause mortality (HR 2.21, 95% CI 2.12-2.31, p < 0.001) and PVT (HR 40.92, 95% CI 26.48-63.25, p < 0.001). Risks of AMI (HR 1.03, 95% CI 0.93-1.13, p = 0.594) and arterial embolism (HR 0.91, 95% CI 0.38-2.13, p = 0.819) were comparable. HCC patients showed increased GIB (HR 1.72, 95% CI 1.56-1.90, p < 0.001) and melena (HR 1.86, 95% CI 1.68-2.07, p < 0.001), while ICH risk was similar (HR 0.97, 95% CI 0.77-1.22, p = 0.789). Conclusions: Anticoagulated AF patients with HCC have significantly increased risks of all-cause mortality, portal vein thrombosis, and gastrointestinal hemorrhage compared to those without HCC. These findings highlight the importance of individualized anticoagulation strategies and monitoring. Comparison of risk ratios (HRs) and P-values for atrial fibrillation (AF) outcomes with and without hepatocellular carcinoma (HCC): This table presents the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for various outcomes in anticoagulated AF patients with HCC compared to those without HCC. Outcome HR (95% CI) P-value All-cause Mortality 2.21 (2.12-2.31) <0.001 Ischemic Stroke 1.05 (0.95-1.16) 0.315 Acute Myocardial Infarction (AMI) 1.03 (0.93-1.13) 0.594 Deep Vein Thrombosis (DVT) 1.15 (1.02-1.30) 0.024 Pulmonary Embolism (PE) 1.22 (1.08-1.38) 0.002 Portal Vein Thrombosis (PVT) 40.92 (26.48-63.25) <0.001 Intracranial Hemorrhage (ICH) 0.97 (0.77-1.22) 0.789 Gastrointestinal Bleeding (GIB) 1.72 (1.56-1.90) <0.001 Melena 1.86 (1.68-2.07) <0.001