Abstract
MANAGEMENT OF ATRIAL FIBRILLATION IN PATIENTS WITH CIRRHOSIS: A LITERATURE REVIEW

*Jaouad Nguadi, Youssef Lahmouz, Hanae El Ghiati, Jihane Fagouri, Hicham Bouzelmat, Ali Chaib

ABSTRACT

Atrial fibrillation (AF) is increasingly prevalent in patients with liver cirrhosis, with estimates ranging from 8–25%, driven by hemodynamic, inflammatory, and coagulopathic alterations. This population faces heightened risks of thromboembolism and catastrophic bleeding due to portal hypertension, varices, and thrombocytopenia. This review synthesizes epidemiology, pathophysiology, risk stratification, and management strategies, aligned with the latest societal guidelines (ACC/AHA/ACCP/HRS 2023, ESC 2024). Oral anticoagulation (OAC) is challenging owing to unpredictable pharmacokinetics and bleeding propensity; vitamin K antagonists (VKAs) and reduced-dose direct oral anticoagulants (DOACs) are conditionally endorsed. Rate control is preferred, with rhythm control reserved for symptomatic cases. Multidisciplinary decision-making integrating hepatology and cardiology is critical.

Keywords: Atrial fibrillation; Liver cirrhosis; Anticoagulation; Guidelines; Portal hypertension.


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