Anticoagulation for Stroke Prevention in Atrial Fibrillation and Treatment of Venous Thromboembolism and Portal Vein Thrombosis in Cirrhosis

We recommend that patients with Child-Pugh A or B cirrhosis with AF and CHA2DS2VASc score of 2 or greater in males and 3 or greater in females be anticoagulated for stroke prevention as per current guideline recommendations in patients without cirrhosis unless otherwise contraindicated. There is inadequate evidence with respect to the benefit and risk of anticoagulation in patients with Child-Pugh C cirrhosis.

We recommend patients with cirrhosis and acute DVT/PE are offered treatment with anticoagulation barring a contraindication such as active bleeding, in keeping with current guideline recommendations for patients without cirrhosis.