Rivaroxaban-induced hepatotoxicity: review of the literature and report of new cases

Abstract

Direct-acting oral anticoagulants have been commonly prescribed, even if safety issues regarding the use of these drugs are still an ongoing concern, especially in patients experiencing chronic liver disease. Dedicated postauthorization safety studies should be undertaken to better define rivaroxaban-induced drug-induced liver injury.

Use of New Oral Anticoagulants/ Direct Oral Anticoagulants in Malignant Patients

“…NOACs are also metabolized by the liver enzyme CYP450 3A and may sometimes produce symptoms which result in elevated enzymes in patients. This question arose because ximelagatran showed hepatotoxic symptoms in its initial stages while the currently used NOACs found no hepatic risk [1,8]. Although NOACs induced hepatotoxicity is unusual, it has evidence of drug-induced liver injury as well as elevated enzyme levels of the liver [8].…”

“…This question arose because ximelagatran showed hepatotoxic symptoms in its initial stages while the currently used NOACs found no hepatic risk [1,8]. Although NOACs induced hepatotoxicity is unusual, it has evidence of drug-induced liver injury as well as elevated enzyme levels of the liver [8]. There is a little more evidence which suggested that NOACs cannot be used in hepatic impairment [27].…”

“…They have a wide therapeutic range and greater bioavailability, but there are risks of bleeding especially in cancer patients and several other risks associated with NOACs [2]. Today, NOACs are used equally as warfarin and some NOACs are considered superior to warfarin as they have low adverse effects as compared to warfarin, but still there are some major pitfalls in the use of NOAC drugs such as increased bleeding, elevation of liver enzymes, and others [8]. NOACs also have some challenging issues, as these are primarily excreted through the kidney, so the safety of these drugs in renal impairment is a great challenge [9][10].…”

Hepatotoxicity of New Oral Anticoagulants

“…После этого были также исключены статьи, в которых не приводятся описания конкретных клинических случаев, итого -в обзор включено 14 статей (рис. 1) [14,15,[17][18][19][20][21][22][23][25][26][27][28][29].…”

“…Следует обратить внимание, что практически во всех случаях развития гепатотоксичности купирование лабораторных симптомов происходило после отмены ривароксабана, без применения дополнительной терапии. Нормализация лабораторных показателей и купирование клинических проявлений обычно происходило через неделю после отмены ЛС [18][19][20][21]. Возможные механизмы вызванной ривароксабаном гепатотоксичности неизвестны и, вероятно, включают сложные взаимодействия нескольких редких факторов и иммунно-опосредованных реакций.…”