title: Established and new-generation antithrombotic drugs in patients with cirrhosis - possibilities and caveats.
abstract: Until recently, it was widely accepted that patients with cirrhosis have a bleeding tendency related to the changes in the hemostatic system that occur as a consequence of the disease. However, it has now been well established that patients with cirrhosis are at risk for both bleeding and thrombotic complications. These thrombotic complications include portal vein thrombosis, deep vein thrombosis and pulmonary embolism, and coronary or cerebrovascular infarctions. Antithrombotic drugs to prevent or treat thrombotic complications in patients with cirrhosis have been used only minimally in the past due to the perceived bleeding risk. As the thrombotic complications and the necessity of antithrombotic treatment in these patients are increasingly recognized, the use of antithrombotic drugs in this population is likely increasing. Moreover, given the rising incidence of fatty liver disease and generally longer survival times of patients with chronic liver diseases, it would be reasonable to presume that some of these thrombotic complications may be increasing in incidence over time. In this review, we will outline the indications for antithrombotic treatment in patients with cirrhosis. Furthermore, we will discuss the available antithrombotic drugs and indicate possible applications, advantages, and caveats. Since for many of these drugs very little experience in patients with cirrhosis exists, these data are essential in the design of future clinical and laboratory studies on mechanisms, efficacy, and safety of the various antithrombotic strategies in these patients.
authors.affiliation: Department of Surgery, Section of Hepatobiliairy Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.a.lisman@umcg.nl
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D000069604:Dabigatran; D018450:Disease Progression; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology; D014812:Vitamin K / Q000037:antagonists & inhibitors; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D005343:Fibrinolytic Agents; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D015091:beta-Alanine; D014812:Vitamin K; D006493:Heparin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Anticoagulant drugs; Arterial thrombosis; Cirrhosis; DVT; GI; HIT; INR; LMWH; NAFLD; NASH; PT; PVT; Portal vein thrombosis; Thrombosis; Treatment; VKA; Venous thrombosis; aPTT; activated partial thromboplastin time; deep vein thrombosis; gastrointestinal; heparin-induced thrombocytopenia; international normalized ratio; low molecular weight heparin; non-alcoholic fatty liver disease; non-alcoholic steatohepatitis; portal vein thrombosis; prothrombin time; vitamin K antagonists