Blood-thinning medications linked to fewer liver failure complications
Patients with liver cirrhosis and atrial fibrillation who were treated with blood-thinning medications had a lower risk of developing severe liver-related complications. This is shown in a nationwide registry study from Karolinska Institutet published in the journal Clinical and Molecular Hepatology. The findings also suggest that the treatment is not associated with an increased risk of major bleeding.
Liver cirrhosis is a condition in which the liver becomes scarred and damaged. Due to the liver’s considerable reserve capacity, the disease is often initially compensated and symptom-free. As the condition progresses, patients may develop what is known as decompensated cirrhosis, which involves complications such as fluid accumulation in the abdomen, gastrointestinal bleeding and liver failure. At the same time, many patients with cirrhosis also have atrial fibrillation, a heart rhythm disorder that is often treated with blood-thinning medications to prevent stroke. Researchers have long debated whether these medicines may also influence the course of liver cirrhosis.
In the current study, researchers analysed data from 1,160 patients with compensated liver cirrhosis and newly diagnosed atrial fibrillation, identified through Swedish national health registers. Of these, 383 started treatment with a blood-thinning medication, while 777 did not. The researchers followed the patients for up to five years and compared the risk of liver-related complications and major bleeding.
Lower risk of severe complications
After five years, 10.4 per cent of patients who had started treatment had developed decompensated cirrhosis, compared to 16.6 per cent of those who were not treated. The reduction in risk was seen primarily for fluid accumulation in the abdomen, known as ascites.
“Our findings suggest that blood-thinning medications used in the treatment of atrial fibrillation may be associated with a lower risk of severe complications in liver cirrhosis, without an increased risk of major bleeding,” says Axel Wester, physician and researcher at the Department of Medicine, Huddinge, Karolinska Institutet, and first author of the study.
An important question was whether the treatment increased the risk of major bleeding, something that has long contributed to caution when treating patients with cirrhosis. After five years, 19.0 per cent of treated patients had experienced a major bleeding event, compared with 19.8 per cent of those who did not receive treatment. The researchers also found no clear differences in fatal bleeding, intracranial bleeding, or gastrointestinal bleeding.
The study is observational, meaning that the researchers did not randomly assign patients to receive treatment or no treatment. As a result, it is not possible to establish a causal relationship with certainty.
“Randomised clinical trials are needed to determine conclusively whether treatment with blood-thinning medications actually reduce the risk of decompensated cirrhosis. However, our findings support the rationale for conducting such studies,” says Axel Wester.
The study was carried out in collaboration between researchers at Karolinska Institutet, Karolinska University Hospital and Quantify Research. Funding was provided, among others, by the Swedish Gastrointestinal Foundation, the Professor Nanna Svartz Foundation, Region Stockholm, the Swedish Society of Medicine, Forte, the Swedish Research Council and the Swedish Cancer Society. The researchers report certain institutional research grants and consultancy assignments unrelated to the present study.
Publication
Oral anticoagulants and hepatic decompensation in patients with cirrhosis and atrial fibrillation: observational study.
Axel Wester, Emilie Toresson Grip, Rupesh Rajani, Anthony A Matthews, Hannes Hagström, Ying Shang. Clinical and Molecular Hepatology, online 15 July 2026, doi: 10.3350/cmh.2026.0286.