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Antithrombotic treatment with direct‐acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis
Author(s) -
De Gottardi Andrea,
Trebicka Jonel,
Klinger Christoph,
Plessier Aurélie,
Seijo Susana,
Terziroli Benedetta,
Magenta Lorenzo,
Semela David,
Buscarini Elisabetta,
Langlet Philippe,
Görtzen Jan,
Puente Angela,
Müllhaupt Beat,
Navascuès Carmen,
Nery Filipe,
Deltenre Pierre,
Turon Fanny,
Engelmann Cornelius,
Arya Rupen,
Caca Karel,
PeckRadosavljevic Markus,
Leebeek Frank W. G.,
Valla Dominique,
GarciaPagan Juan Carlos
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13285
Subject(s) - medicine , rivaroxaban , apixaban , dabigatran , portal vein thrombosis , cirrhosis , thrombosis , atrial fibrillation , surgery , warfarin
Background Direct‐acting oral anticoagulants ( DOAC s) are used in patients with splanchnic vein thrombosis ( SVT ) and cirrhosis, but evidence for safety and efficacy in this setting is limited. Our aim was to identify indications and reasons for starting or switching to DOAC s and to report adverse effects, complications and short‐term outcome. Methods Data collection including demographic information, laboratory values, treatment and complications through the Vascular Liver Disease Interest Group Consortium. Results Forty‐five centres (90%) of the consortium completed the initial eCRF . We report here a series of 94 patients from 17 centres. Thirty‐six patients (38%) had cirrhosis. Child‐Pugh score was 6 (range 5‐8), and MELD score 10.2 (range 6‐19). Indications for anticoagulation were splanchnic vein thrombosis (75%), deep vein thrombosis (5%), atrial fibrillation (14%) and others (6%). DOAC s used were rivaroxaban (83%), dabigatran (11%) and apixaban (6%). Patients were followed up for a median duration of 15 months (cirrhotic) and 26.5 months (non‐cirrhotic). Adverse events occurred in 17% of patients and included one case of recurrent portal vein thrombosis and five cases of bleeding. Treatment with DOAC s was stopped in three cases. The major reasons for choosing DOAC s were no need for monitoring or inadequacy of INR to guide anticoagulation in cirrhotic patients. Renal and liver function did not change during treatment. Conclusions A consistent number of patients with SVT and/or cirrhosis are currently treated with DOAC s, which seem to be effective and safe. These data provide a basis for performing randomized clinical trials of DOAC s vs. low molecular weight heparin or vitamin K antagonists.