AC use in patients with cirrhosis and AF has long been debated, and new evidence clarifies how treatment decisions affect clinical outcomes during hospitalization. The study, published in Circulation, examined the impact of AC on mortality and complications in this high-risk group.

A retrospective cohort analysis of the NIS (2016–2021) identified 11,140 adults hospitalized with cirrhosis and AF. Of these, 2,417 (21.7%) received AC. Multivariable regression models adjusted for demographics, comorbidities, and hospital characteristics.

AC was associated with reduced in-hospital mortality (aOR 0.75; 95% CI 0.58–0.98). Lower rates of ICU admission (aOR 0.65; 95% CI 0.50–0.84), AMI (aOR 0.71; 95% CI 0.54–0.95), and GI bleeding (aOR 0.75; 95% CI 0.62–0.90) were also observed. No significant differences were reported in LOS, THC, mesenteric ischemia, PVT, VTE (DVT/PE), cardiac arrest, transfusion, or ICH.

These findings demonstrate that AC provides clinical benefit without increasing major complications in hospitalized patients with cirrhosis and AF. The results highlight the value of individualized decision-making rather than default avoidance of AC in this population.