Dabigatran as an oral anticoagulant in patients with Budd–Chiari syndrome post‐percutaneous endovascular intervention

Abstract

Background and Aim Anticoagulants play an important role in the management of Budd–Chiari syndrome. There is a paucity of data on the efficacy and safety of direct‐acting oral anticoagulants—dabigatran, among patients with Budd–Chiari syndrome. Methods In a retrospective analysis of prospectively maintained data, the stent patency rates, major bleeding episode, and a composite endpoint of major bleed and/or mortality rates were compared between Budd–Chiari syndrome patients treated with dabigatran (n = 36) or vitamin K antagonists (n = 62) following endovascular intervention. Results The baseline characteristics, including sites of block and types of interventions, were similar between the two groups. The mean duration of follow‐up in the dabigatran and vitamin K antagonist groups was 10.5 ± 6.7 and 14.1 ± 6.9 months (P = 0.006), respectively. The endovascular stent patency rates were comparable between the dabigatran and vitamin K antagonist groups at 6 months (91% vs 96.5%) and 12 months (91% vs 93%), P = 0.296 (log‐rank test), respectively. Major bleeding events were comparable between the dabigatran and vitamin K antagonist groups at 6 months (3.5% vs 2%) and 12 months (3.5% vs 6.5%), P = 0.895 (log‐rank test), respectively. The composite endpoint of mortality and major bleed was comparable between dabigatran and vitamin K antagonists at 6 months (4% vs 5%) and 12 months (4% vs 8%), P = 0.875 (log‐rank test), respectively. Conclusions Dabigatran, as compared with vitamin K antagonists, is associated with similar stent patency rates and complications among patients with Budd–Chiari syndrome post‐endovascular intervention.

Anticoagulant therapy for splanchnic vein thrombosis

“…At 18month follow-up, there were no significant differences between dabigatran and VKAs in terms of stent patency (91% and 93%, respectively), major bleeding (3% and 6%, respectively), and survival (87% and 95%, respectively). 45 12. In patients with chronic splanchnic vein thrombosis, we recommend carefully evaluating the use of anticoagulant therapy on a case-by-case basis and considering a watchful approach in selected patients to minimize bleeding.…”

Direct oral anticoagulants for unusual‐site venous thromboembolism

“…Several small observational cohort studies 25‐32 described the use of DOACs in patients with SVT. However, most of them had a retrospective design or used radiological (eg, vein recanalization) instead of clinical outcomes; thus, high‐quality evidence on this topic is limited.…”

“…Sharma et al 28 evaluated a cohort of patients with BCS after endovascular intervention, 36 treated with dabigatran and 62 with VKAs, matched by age, sex, and site of obstruction. Dabigatran resulted in similar rates of stent patency compared to VKAs (91% vs 93% at 1‐year follow‐up), without increasing MB (3.5% vs 6.5%) 28 …”

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

“…The main studies evaluating the use of the DOACs in patients with SVT are summarized in Table 2. These were mainly small observational studies, either retrospective [97][98][99][100][101][102] or prospective [103], with only one RCT [104]. The number of patients treated with DOAC ranged from 12 [98] to 93 [102] patients.…”

“…The average anticoagulant treatment duration ranged from 6 [99] to 10.8 [103] months. One study evaluated dabigatran [100], one edoxaban [99], and one rivaroxaban [104], and five cohorts evaluated different DOACs [97,98,[101][102][103]. Three cohorts included patients treated with the DOACs for different clinical indications [97,98,103], and no separate data were reported for SVT patients.…”