Antithrombotic treatment with direct‐acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis

• Published in: Liver international Vol. 37; no. 5; pp. 694 - 699
• Main Authors: 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, Peck‐Radosavljevic, Markus, Leebeek, Frank W. G., Valla, Dominique, Garcia‐Pagan, Juan Carlos, Grønbæk, Henning, Beer, Jürg‐Hans, Genescà, Joan, Hidalgo, Canete, Vila, Carmen, Mihailovic, Jelena, Piscaglia, Fabio, Lasser, Luc, Fernandez‐Bermejo, Miguel, Procopet, Bogdan, Schouten, Jeoffrey, Spahr, Laurent, Sanchez, José Louis, Zipprich, Alexander, Sekhar, Mallika, Hernandez‐Guerra, Manuel, Laguna, La, Nevens, Frederik, Ferreira, Carlos Noronha, Heneghan, Michael, Albillos, Agustin, Llop, Elba, Dell'Era, Alessandra, La Mura, Vincenzo, Primignani, Massimo, Senzolo, Marco, Escarda, Ana, Mallorca, Palma, Riggio, Oliviero, Murad, Sarwa Darwish, Haas, Stephan, Bureau, Christophe, Berenguer, Marina
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2017
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antagonists; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; anticoagulation; Atrial Fibrillation - drug therapy; Bleeding; Budd‐Chiari syndrome; Cirrhosis; Clinical trials; Coagulation; Complications; Consortia; Data collection; Demographics; Europe; Female; Fibrillation; Gastrointestinal Hemorrhage - chemically induced; Heparin; Humans; Kidneys; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver diseases; Male; Medical research; Middle Aged; Molecular weight; Patients; Portal vein; portal vein thrombosis; Renal function; Side effects; Splanchnic Circulation - physiology; Switching; Thromboembolism; Thrombosis; Venous Thrombosis - drug therapy; Vitamin K; Vitamin K - antagonists & inhibitors; Young Adult; Budd-Chiari syndrome; portal vein thrombosis; cirrhosis; anticoagulation
• ISSN: 1478-3223; 1478-3231; 1478-3231
• DOI: 10.1111/liv.13285

Background Direct‐acting oral anticoagulants (DOACs) 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 DOACs 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%). DOACs 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 DOACs was stopped in three cases. The major reasons for choosing DOACs 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 DOACs, which seem to be effective and safe. These data provide a basis for performing randomized clinical trials of DOACs vs. low molecular weight heparin or vitamin K antagonists.