Background Patients with cirrhosis are more susceptible to both thrombosis and bleeding. Using anticoagulant and antiplatelet agents is often a double-edged sword-reducing thrombotic risk on one hand while increasing bleeding risk on the other hand. This study aims to evaluate the prevalence of anticoagulant and antiplatelet usage and the clinical profile of a territory-wide cohort of patients with cirrhosis.

Methods This was a territory-wide retrospective cohort study of 31,542 cirrhotic patients diagnosed between 2000 and 2020 in Hong Kong. The clinical, laboratory, and medication data were collected. Anticoagulant and/or antiplatelet users were defined as those with a prescription of these medications for 4 weeks or more.

Results 9,373 (29.7%) patients were identified as anticoagulant and/or antiplatelet users; their mean age was 67.5±12.1 years; 63.4% were men; 2,761 (29.5%) had MELD score >10; most of them (70.7%) suffered from chronic hepatitis B. Aspirin was the most commonly used medication(N=8337), with the longest duration (37.6 IQR:6.1-94.5months). Among antiplatelet users, aspirin users and clopidogrel users had similar age and clinical characteristics. Among anticoagulant users, direct oral anticoagulant (DOAC) users were older than warfarin users (age 72.7±11.1 vs. 63.8±13.5 years, p<0.001) but had better renal function and lower MELD score (IDDF2024-ABS-0360 Table 1).

Conclusions Anticoagulants and antiplatelet agents are commonly used in patients with liver cirrhosis, even in some patients with hepatic decompensation. DOACs are preferentially prescribed to younger patients with better renal and liver function. Studies to evaluate the efficacy and safety of these medications in the presence of cirrhosis are warranted.