Direct Oral Anticoagulants in Cirrhotic Patients: Current Evidence and Clinical Observations

Sherif Elhosseiny, Hassan Al Moussawi, Jean M Chalhoub, James Lafferty, Liliane Deeb, Sherif Elhosseiny, Hassan Al Moussawi, Jean M Chalhoub, James Lafferty, Liliane Deeb

Abstract

The introduction of Direct Oral Anticoagulants (DOACs) to the pharmaceutical market provided patients and clinicians with novel convenient and safe options of anticoagulation. The use of this class of medications is currently limited to venous thromboembolic therapy and prophylaxis, in addition to stroke prophylaxis in patients with nonvalvular atrial fibrillation. Despite their altered hemostasis, patients with cirrhosis are thought to be in a procoagulant state and thus prone to thrombus formation. Patients with cirrhosis might benefit from the convenience of DOACs; however, the medical literature includes limited data on the efficacy and safety of DOACs in this special patient population. The aim of this review is to summarize the current evidence for anticoagulation options in patients with cirrhosis and their safety profile.

Figures

Figure 1
Figure 1
The effect on anticoagulants on the coagulation cascade.
Figure 2
Figure 2
Recommended algorithm for DOACs therapy initiation in cirrhosis. CTP: Child Turcotte Pugh score. EVL: Endoscopic Variceal Ablation (see Table 2).

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Source: PubMed

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