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

Gottardi, Andrea De; Trebicka, Jonel; Klinger, Christoph; Plessier, Aurélie; Seijó, Susana; Terziroli, Benedetta; Magenta, Lorenzo; Semela, David; Buscarini, Elisabetta; Langlet, Philippe; Görtzen, Jan; Puente, Ángela; Müllhaupt, Beat; Navascués, C.A.; Nery, Filipe; Deltenre, Pierre; Turón, Fanny; Engelmann, Cornelius; Arya, R.; Caca, Karel; Peck‐Radosavljevic, Markus; Leebeek, Frank W.G.; Valla, Dominique; García-Pagán, Juan Carlos

doi:10.1111/liv.13285

Cited by 194 publications

(145 citation statements)

References 24 publications

Supporting

Mentioning

143

Contrasting

Unclassified

Order By: Relevance

“…Current expert recommendations propose a very restrictive prophylactic prohaemostatic management, and a more active anticoagulant approach . Importantly, anticoagulant therapy in patients with cirrhosis is challenging, and new generation anticoagulant drugs have not been extensively studied in patients with cirrhosis, although the clinical use in these patients is increasing …”

Section: Introductionmentioning

confidence: 99%

In vitro efficacy of pro‐ and anticoagulant strategies in compensated and acutely ill patients with cirrhosis

Lisman

Kleiss

Patel

et al. 2018

Liver International

View full text Add to dashboard Cite

Background & AimsA simultaneous decline in pro‐ and anticoagulant drivers in patients with liver diseases results in a “rebalanced” haemostatic system, even in acutely ill patients. Nevertheless, both bleeding and thrombotic events are common. Here, we explored efficacy of pro‐ and antihaemostatic strategies in compensated and acutely ill cirrhotics which may be unpredictable given the profound haemostatic changes.MethodsWe tested the effects in vitro of the addition of clinically relevant doses of commonly used pro‐ and antihaemostatic strategies in plasma from healthy individuals (n = 30) and patients with compensated (n = 18) and acutely decompensated cirrhosis (n = 18), and acute‐on‐chronic liver failure (n = 10). We used thrombin generation tests and fibrin clot permeability assays to assess potency of various approaches.ResultsFresh frozen plasma and recombinant factor VIIa modestly increased thrombin generation (10%‐20%). Prothrombin complex concentrate increased thrombin generation two‐fold in controls and 2‐4‐fold in patients. Clot permeability decreased after addition of fibrinogen concentrate by 51% in controls and by 50%‐60% in patients. Low molecular weight heparin decreased thrombin generation by 18% in controls and by 23%‐54% in patients. Similarly, dabigatran decreased thrombin generation by 33% in controls and by 47%‐100% in patients. In contrast, rivaroxaban decreased thrombin generation by 55% in controls, but only by 11%‐38% in patients.ConclusionsThese in vitro data suggest little prohaemostatic effect of fresh frozen plasma and recombinant factor VIIa in acutely ill cirrhotics, whereas prothrombin complex concentrate and fibrinogen concentrate clearly improved haemostasis. Furthermore, our data suggest the requirement for dose adjustments of commonly used anticoagulants in these patients.

show abstract

Section: Introductionmentioning

confidence: 99%

In vitro efficacy of pro‐ and anticoagulant strategies in compensated and acutely ill patients with cirrhosis

Lisman

Kleiss

Patel

et al. 2018

Liver International

View full text Add to dashboard Cite

show abstract

“…Two series have been published so far reporting the use of DOACs in patients with splanchnic vein thrombosis [5, 6]. The results of these two papers strongly suggest that this new class of anticoagulants is safe, since the incidence of major bleedings and other drug-induced side effects was similar as in patients treated with conventional anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…The use of DOACs is being generalized [4], but they are not routinely used in PVT and are not yet mentioned in the latest guidelines as an alternative treatment [1]. Recent data, however, indicate that this new class of anticoagulants is increasingly used also in patients with splanchnic vein thrombosis [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Direct-Acting Oral Anticoagulants Use in Acute Portal Vein Thrombosis Unrelated to Cirrhosis

et al. 2017

Self Cite

View full text Add to dashboard Cite

In acute portal vein thrombosis (APVT) unrelated to cirrhosis, anticoagulant therapy is classically started with low molecular weight heparin or vitamin K antagonists. New direct-acting oral anticoagulants (DOACs) are used in the treatment of venous thrombosis outside the splanchnic vascular bed, but not in the latter. We report a young female with APVT occurring in a non-cirrhotic liver linked to heterozygosity of factor V-Leiden and prothrombin G20210A gene mutations. Rivaroxaban was started, with total recanalization of the left and partial recanalization of the right portal vein branches, without complications. New DOACs do not need daily subcutaneous injections nor routinely blood coagulation control tests, making its use attractive, eventually increasing patient’s compliance. If proved to be safe and effective in the future studies, its use may be extended to PVT treatment. This case shows that rivaroxaban was safe, not only prevented the extension of thrombosis in the portal tract, but also resolved PVT, at least partially.

show abstract

“…Moreover, first data show that use of DOAC is safe in cirrhotic patients [50,51]. However, the experience with DOACs is still limited and a strong recommendation cannot be made until more studies have become available.…”

Section: Managementmentioning

confidence: 99%

Portal vein thrombosis in patients with cirrhosis

Köckritz

Gottardi

Trebicka

et al. 2017

Gastroenterology Report

Self Cite

View full text Add to dashboard Cite

Portal vein thrombosis (PVT) is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare, but can be life-threatening. However, different aspects of clinical relevance, diagnosis and management of PVT are still areas of uncertainty and investigation in international guidelines. In this article, we elaborate on PVT classification, geographical differences in clinical presentation and standards of diagnosis, and briefly on the current pathophysiological understanding and risk factors. This review considers and highlights the pitfalls of the various treatment approaches and prophylactic treatments. Finally, we review the controversial issue of clinical impact of PVT on prognosis, especially considering liver transplantation and future perspectives.

show abstract

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

Abstract: 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.

Cited by 194 publications

References 24 publications

In vitro efficacy of pro‐ and anticoagulant strategies in compensated and acutely ill patients with cirrhosis

In vitro efficacy of pro‐ and anticoagulant strategies in compensated and acutely ill patients with cirrhosis

Efficacy and Safety of Direct-Acting Oral Anticoagulants Use in Acute Portal Vein Thrombosis Unrelated to Cirrhosis

Portal vein thrombosis in patients with cirrhosis

Contact Info

Product

Resources

About