title: Direct Oral Anticoagulants in Cirrhosis Patients Pose Similar Risks of Bleeding When Compared to Traditional Anticoagulation.
abstract: Direct oral anticoagulants (DOAC) are important new anticoagulant therapies that are not well studied in patients with chronic liver disease. The aim of this study was to compare rates of bleeding in cirrhosis patients treated with DOAC (factor Xa inhibitors: rivaroxaban and apixaban) to those in cirrhosis patients treated with traditional anticoagulation (warfarin and low molecular weight heparin).
  
  
  
  We identified a total of 39 patients with cirrhosis who received anticoagulation therapy over a 3-year period (20 DOAC and 19 traditional anticoagulation) from a research database. Medical records were reviewed to obtain clinical data to compare between the groups.
  
  
  
  Clinical characteristics between the two groups were similar. There were three documented bleeding events in the traditional anticoagulation group and four bleeding events in the DOAC group (p = 0.9). There were two major bleeding events in the traditional anticoagulation group and one major bleeding event in the DOAC group. There were no documented reports of drug-induced liver injury during this study period. Among all patients, no significant predictors of bleeding were identified using univariate regression and Cox proportional hazard modeling.
  
  
  
  This is the first clinical study evaluating the use of DOAC in patients with cirrhosis. DOAC display similar safety characteristics when compared to traditional anticoagulation in patients with cirrhosis and are potentially attractive agents for anticoagulation therapy. Larger studies are now needed to better understand the safety and efficacy of these agents in cirrhosis.
authors.affiliation: Coagulation in Liver Disease Study Group, Division of Gastroenterology and Hepatology, University of Virginia Medical Center, PO Box 800708, Charlottesville, VA, 22908, USA. intagliata@virginia.edu.
authors.forename: N M
authors.initials: NM
authors.lastname: Intagliata
authors.affiliation: Coagulation in Liver Disease Study Group, Division of Gastroenterology and Hepatology, University of Virginia Medical Center, PO Box 800708, Charlottesville, VA, 22908, USA.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Henry
authors.affiliation: Division of Hematology and Oncology, University of Virginia Medical Center, PO Box 800716, Charlottesville, VA, 22908, USA.
authors.forename: H
authors.initials: H
authors.lastname: Maitland
authors.affiliation: Coagulation in Liver Disease Study Group, Division of Gastroenterology and Hepatology, University of Virginia Medical Center, PO Box 800708, Charlottesville, VA, 22908, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Shah
authors.affiliation: Coagulation in Liver Disease Study Group, Division of Gastroenterology and Hepatology, University of Virginia Medical Center, PO Box 800708, Charlottesville, VA, 22908, USA.
authors.forename: C K
authors.initials: CK
authors.lastname: Argo
authors.affiliation: Coagulation in Liver Disease Study Group, Division of Gastroenterology and Hepatology, University of Virginia Medical Center, PO Box 800708, Charlottesville, VA, 22908, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Northup
authors.affiliation: Coagulation in Liver Disease Study Group, Division of Gastroenterology and Hepatology, University of Virginia Medical Center, PO Box 800708, Charlottesville, VA, 22908, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Caldwell
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D012307:Risk Factors
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Bleeding; Cirrhosis; Coagulation; DOAC; Factor Xa inhibitor; Portal vein thrombosis; Thrombosis