Baylo A. Optimization of anticoagulation management in patients with liver cirrhosis and atrial fibrillation

Liver cirrhosis (LC) and atrial fibrillation (AF) as separate diseases are among the most serious problems of modern internal medicine, as they are accompanied by significant prevalence, morbidity, reduced quality of life and mortality. According to a meta-analysis, the prevalence of AF in patients with cirrhosis is 5-7.4%, which is higher than the prevalence of AF in general population. The combined pathology of AF and liver cirrhosis is accompanied by a higher rate of hospitalization, hospital mortality and more frequent occurrence of such serious complications as ischemic stroke and acute renal failure, compared with the isolated course of liver cirrhosis. The reason for such situation may be the lack of proper treatment and the lack or unavailability in clinical practice of diagnostic methods that can give a complete picture of complex processes that occur in patients with liver cirrhosis and atrial fibrillation. Although AF is one of the most common diseases in the world, it is currently unknown how it may affect hemostasis in patients with liver cirrhosis and what clinical consequences it may provoke. An important scientific problem is searching for diagnostic methods that can accurately and correctly assess complex hemostasis system changes in patients with liver cirrhosis and atrial fibrillation, as currently existing are incorrect, invalid or insensitive. Also, among the important scientific issues remains the anticoagulation management in patients with liver cirrhosis and AF. The need for anticoagulant prophylaxis in patients with AF to reduce the risk of thrombotic complications is evidence based and well-studied, while for combined pathology of liver cirrhosis and AF there are no clear official guidelines for thromboprophylaxis based on clinical trials. Data from large-scale cohort retrospective studies of patients with liver cirrhosis and AF confirm the effectiveness of anticoagulants compared with antiplatelet agents and placebo - after treatment the risk of thrombotic complications was significantly reduced without significantly increased risk of bleeding. However, more information is needed investigating efficacy and safety of anticoagulants compared to each other and their effect on hemostasis system, functional state of the liver and kidneys in this category of patients. The aim of the study. Improving anticoagulation management in patients with liver cirrhosis and atrial fibrillation based on a comprehensive assessment and comparison of clinical features, liver and kidney function, hemostasis before and after warfarin and dabigatran treatment and risk assessment of thromboembolic and hemorrhagic complications during the treatment. Objectives of the study. 1. To study the clinical and laboratory features of the combined course of liver cirrhosis and AF. 2. To assess hemostasis system in patients with liver cirrhosis and AF using standard coagulation parameters. 3. To assess hemostasis system in patients with liver cirrhosis and AF using parameters of global test of hemostasis assessment LPTEG. 4. To determine the effect of dabigatran and warfarin on parameters of complete blood count, liver and kidney function in patients with liver cirrhosis and AF. 5. To evaluate the effect of dabigatran and warfarin on hemostasis system in patients with liver cirrhosis and AF using standard coagulation parameters. 6. Assess the effect of dabigatran and warfarin on hemostasis system in patients with liver cirrhosis and AF using parameters of global test of hemostasis assessment LPTEG. 7. To analyze the frequency and risk factors for thrombotic and hemorrhagic complications in patients with liver cirrhosis and AF.