Direct-acting Oral Anticoagulants in Liver Cirrhosis: What is the Current Status?

Pp: 334-346 (13)

Abstract

In the last few years, the coagulation abnormalities associated with liver cirrhosis were better characterized, concluding that the patients with liver cirrhosis are predisposed to thrombotic or bleeding complications. Portal vein thrombosis is the most frequent thrombotic event, associated with liver cirrhosis. Atrial fibrillation is also a frequent comorbidity in patients with liver cirrhosis associated with higher risks of embolic complications, needing an anticoagulant prophylactic treatment. Direct-acting oral anticoagulants (DOACs), warfarin, unfractionated heparin or low weight molecular heparin are not always efficient in liver cirrhosis. According to recent studies, DOACs are relatively safe in Child-Pugh class A or B liver cirrhosis for the treatment of acute portal vein thrombosis or prevention of embolic events in patients associating atrial fibrillation. All DOACs are contraindicated in patients with ChildPugh class C liver cirrhosis.

Keywords: Anticoagulation, Atrial fibrillation, Direct-acting oral anticoagulants, Liver cirrhosis, Portal vein thrombosis, Thrombosis.

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