Anticoagulation in patients with atrial fibrillation and liver cirrhosis

Atrial fibrillation (AF) is an increasingly recognized comorbidity in patients with liver cirrhosis, mainly associated with nonalcoholic fatty liver disease and alcohol-associated liver disease, affecting the quality of life and prognosis. On the other hand, cirrhosis is associated with an elevated risk of both thrombosis and bleeding, making the decision about anticoagulation therapy very challenging. Direct-acting oral anticoagulants (DOACs) are approved for patients with non-valvular AF. However, there is limited clinical experience and scientific evidence about their efficacy and safety in liver cirrhosis. This review article investigates the published literature concerning the administration of DOACs and traditional antithrombotic agents, such as vitamin K antagonists and heparins, in patients with liver cirrhosis and AF.