Direct oral anticoagulants in patients with liver cirrhosis: A systematic review

Thrombosis Research
Evert Willian HoolwerfNick van Es

Abstract

Anticoagulant treatment in patients with liver cirrhosis is challenging. The aim of this systematic review was to evaluate clinical outcomes of direct oral anticoagulant (DOAC) therapy in cirrhosis patients. A systematic search was performed in MEDLINE, Embase, and conference proceedings up to November 7th, 2017, for studies that evaluated the efficacy and safety of DOACs in cirrhosis patients with venous thromboembolism (VTE), splanchnic vein thrombosis (SVT), or atrial fibrillation (AF). Two authors independently screened titles, abstracts, and full-text articles, and assessed risk of bias. A meta-analysis could not be performed due to heterogeneity of the included studies. Of the 2927 articles assessed, five retrospective cohort studies were included (n = 239, including 20 patients overlap). All studies had fair methodological quality. Two studies evaluated DOAC treatment only, and three also evaluated vitamin K antagonists (VKAs) or low-molecular-weight heparins (LMWHs). Recurrent VTE (DOAC n = 12, LMWH/VKA n = 8) or ischemic stroke (DOAC n = 37, LMWH/VKA n = 9) occurred in none of the patients. Progression of VTE was 8% with DOACs (n = 12) and 13% with VKAs and LWWH (n = 8). Recurrent SVT occurred in 0 to 4% with DOACs (n ...Continue Reading

Citations

Jan 19, 2019·Liver International : Official Journal of the International Association for the Study of the Liver·Alessandro MantovaniGiovanni Targher
Sep 6, 2019·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Yonghui FuWenfeng He
May 28, 2020·Blood·Sarah BosPieter W Kamphuisen
Aug 21, 2020·Seminars in Thrombosis and Hemostasis·Oana Nicoară-FarcăuJuan Carlos García-Pagán
Apr 26, 2019·Liver International : Official Journal of the International Association for the Study of the Liver·Giovanni Targher
Oct 20, 2020·Internal and Emergency Medicine·Francesco VioliDaniele Pastori
Jun 30, 2019·Chest·Parth RaliLisa Moores
Feb 11, 2020·JHEP Reports : Innovation in Hepatology·Laura TurcoErica Villa
Nov 10, 2020·Hepatology Communications·Kelly L Hayward, Rianne A Weersink
Oct 31, 2020·Journal of Thrombosis and Haemostasis : JTH·Sarah BosTon Lisman
Nov 23, 2019·The Thoracic and Cardiovascular Surgeon·Rebecca Grossman, Rohin Francis
Mar 4, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Trevor J WilkeCale A Kassel
May 11, 2021·Clinical Liver Disease·Abhishek ShenoyNicolas M Intagliata
Jun 22, 2021·Liver International : Official Journal of the International Association for the Study of the Liver·Georg SemmlerBernhard Scheiner
Aug 17, 2021·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·Jin Hean KohYu Jun Wong

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