Drug-induced liver injury with oral anticoagulants: a threat or not?

NOACs; (8) NOAC plasma level measurement: rare indications, precautions, and potential pitfalls; (9) How to deal with dosing errors; (10) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (11) Management of bleeding under NOAC therapy; (12) Patients undergoing a planned invasive procedure, surgery or ablation; (13) Patients requiring an urgent surgical intervention; (14) Patients with AF and coronary artery disease; (15) Avoiding confusion with NOAC dosing across indications; (16) Cardioversion in a NOAC-treated patient; (17) AF patients presenting with acute stroke while on NOACs; (18) NOACs in special situations; (19) Anticoagulation in AF patients with a malignancy; and (20) Optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA website (www.NOACforAF.eu).

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“…221 In fact, the risk of liver injury may even be lower than with VKA. [222][223][224] Markers of kidney damage (> _1)…”

Section: Non-vitamin K Antagonist Oral Anticoagulants In Liver Diseasementioning

confidence: 99%

2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation

Steffel¹,

et al. 2021

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“…1188 Management of AF patients with liver disease is challenging, owing to increased bleeding risk (associated with decreased hepatic synthetic function in advanced liver disease, thrombocytopenia, and gastrointestinal variceal lesions), as well as increased ischaemic risk 1189,1190 ). Patients with hepatic dysfunction were generally excluded from the RCTs, 1191 especially those with abnormal clotting tests, as such patients may be at higher risk of bleeding on VKA, possibly less so on NOACs. Despite the paucity of data, observational…”

Section: Atrial Fibrillation and Gastrointestinal Disordersmentioning

confidence: 99%

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

Hindricks¹,

Potpara²,

Dagres³

et al. 2021

Revista Española de Cardiología (English Edition)

322

664

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“…As apixaban has the highest percentage of hepatobiliary metabolism of all NOACs, caution should be taken in the setting of advanced hepatic failure as studies concerning risk profile of this specific patient population are lacking [ 95 ]. Apixaban is metabolized via the CYP450 system leading to certain drug interactions and, just like the other factor Xa inhibitors, apixaban is a substrate of P-glycoprotein [ 96 ].…”

Section: Oral Anticoagulant Drugs For Stroke Prevention In Afmentioning

confidence: 99%

Pharmacological and Non-pharmacological Treatments for Stroke Prevention in Patients with Atrial Fibrillation

et al. 2017

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Atrial fibrillation (AF) is associated with significant risk of stroke and other thromboembolic events, which can be effectively prevented using oral anticoagulation (OAC) with either vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, or edoxaban. Until recently, VKAs were the only available means for OAC treatment. NOACs had similar efficacy and were safer than or as safe as warfarin with respect to reduced rates of hemorrhagic stroke or other intracranial bleeding in the respective pivotal randomized clinical trials (RCTs) of stroke prevention in non-valvular AF patients. Increasing “real-world” evidence on NOACs broadly confirms the results of the RCTs. However, individual patient characteristics including renal function, age, or prior bleeding should be taken into account when choosing the OAC with best risk–benefit profile. In patients ineligible for OACs, surgical or interventional stroke prevention strategies should be considered. In patients undergoing cardiac surgery for other reasons, the left atrial appendage excision, ligation, or amputation may be the best option. Importantly, residual stumps or insufficient ligation may result in even higher stroke risk than without intervention. Percutaneous left atrial appendage occlusion, although requiring minimally invasive access, failed to demonstrate reduced ischemic stroke events compared to warfarin. In this review article, we summarize current treatment options and discuss the strengths and major limitations of the therapies for stroke risk reduction in patients with AF.

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Drug-induced liver injury with oral anticoagulants: a threat or not?

Cited by 9 publications

References 10 publications

2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation

2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

Pharmacological and Non-pharmacological Treatments for Stroke Prevention in Patients with Atrial Fibrillation

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