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10.15. CKD and Kidney Failure
10.16. Anticoagulation Use in Patients With Liver Disease
COR LOE
Recommendations
2a B-NR 1. For patients with AF at increased risk of systemic
thromboembolism and mild or moderate liver disease
(Child-Pugh* class A or B), OAC therapy is reasonable in
the absence of clinically significant liver disease-induced
coagulopathy or thrombocytopenia.
2a B-NR 2. For patients with AF at increased risk of systemic
thromboembolism and mild or moderate liver disease (Child-
Pugh class A or B) who are deemed to be candidates for
anticoagulation, it is reasonable to prescribe DOACs (Child-
Pugh class A: any DOAC; Child-Pugh class B: apixaban,
dabigatran, or edoxaban) over warfarin.
3: Harm C-LD 3. For patients with AF and moderate liver disease (Child-Pugh
class B) at increased risk of systemic thromboembolism,
rivaroxaban is contraindicated due to the potentially
increased risk of bleeding.
* Child-Pugh scoring : the severity of liver disease, primarily cirrhosis in patients with
diagnosed liver disease. Child-Pugh A (mild): 5–6 points; Child-Pugh B (moderate):
7–9 points; Child-Pugh C (severe): 10–15 points. e score is based on the 5 variables:
encephalopathy (none=1 point, grade 1 and 2=2 points, grade 3 and 4= 3 points); ascites
(none=1 point, slight=2 points, moderate=3 points); total bilirubin (<2 mg/mL=1 point,
2–3 mg/mL=2 points, >3 mg/mL=3 points); albumin (>3.5 mg/mL=1 point, 2.8–3.5 mg/
mL=2 points, <2.8 mg/mL=3 points); INR (<1.7=1 point, INR 1.7–2.2=2 points, INR
>2.2=3 points).
