Oral Anticoagulation in Patients With Liver Disease

• Published in: Journal of the American College of Cardiology Vol. 71; no. 19; pp. 2162 - 2175
• Main Authors: Qamar, Arman, Vaduganathan, Muthiah, Greenberger, Norton J., Giugliano, Robert P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.05.2018; Elsevier Limited
• Subjects: Administration, Oral; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; anticoagulation; atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Bleeding; Cardiac arrhythmia; Cardiology; Clinical trials; Clinical Trials as Topic - methods; Complications; Disease control; Disease prevention; Enzymes; Fibrillation; Health risks; Hemorrhage - chemically induced; Hemorrhage - diagnosis; Hemorrhage - epidemiology; Humans; Hypertension; Liver; Liver cirrhosis; liver disease; Liver diseases; Liver Diseases - blood; Liver Diseases - drug therapy; Liver Diseases - epidemiology; Medical prognosis; Metabolism; Observational Studies as Topic - methods; Patients; Pharmacology; Proteins; Stroke; Thromboembolism; Thrombosis; venous thromboembolism; Venous Thromboembolism - blood; Venous Thromboembolism - drug therapy; Venous Thromboembolism - epidemiology; Vitamin K; Warfarin; FDA; NAFLD; bleeding; liver disease; PT; AF; VTE; anticoagulation; NOAC; INR; PVT; OAC; PCC; atrial fibrillation; thrombosis; venous thromboembolism; EMA
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.03.023

Patients with liver disease are at increased risks of both thrombotic and bleeding complications. Many have atrial fibrillation (AF) or venous thromboembolism (VTE) necessitating oral anticoagulant agents (OACs). Recent evidence has contradicted the assumption that patients with liver disease are “auto-anticoagulated” and thus protected from thrombotic events. Warfarin and non–vitamin K–antagonist OACs have been shown to reduce thrombotic events safely in patients with either AF or VTE. However, patients with liver disease have largely been excluded from trials of OACs. Because all currently approved OACs undergo metabolism in the liver, hepatic dysfunction may cause increased bleeding. Thus, the optimal anticoagulation strategy for patients with AF or VTE who have liver disease remains unclear. This review discusses pharmacokinetic and clinical studies evaluating the efficacy and safety of OACs in patients with liver disease and provides a practical, clinically oriented approach to the management of OAC therapy in this population. [Display omitted]