title: Antithrombotic treatment with direct-acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis.
abstract: Direct-acting oral anticoagulants (DOACs) are used in patients with splanchnic vein thrombosis (SVT) and cirrhosis, but evidence for safety and efficacy in this setting is limited. Our aim was to identify indications and reasons for starting or switching to DOACs and to report adverse effects, complications and short-term outcome.
  
  
  
  Data collection including demographic information, laboratory values, treatment and complications through the Vascular Liver Disease Interest Group Consortium.
  
  
  
  Forty-five centres (90%) of the consortium completed the initial eCRF. We report here a series of 94 patients from 17 centres. Thirty-six patients (38%) had cirrhosis. Child-Pugh score was 6 (range 5-8), and MELD score 10.2 (range 6-19). Indications for anticoagulation were splanchnic vein thrombosis (75%), deep vein thrombosis (5%), atrial fibrillation (14%) and others (6%). DOACs used were rivaroxaban (83%), dabigatran (11%) and apixaban (6%). Patients were followed up for a median duration of 15 months (cirrhotic) and 26.5 months (non-cirrhotic). Adverse events occurred in 17% of patients and included one case of recurrent portal vein thrombosis and five cases of bleeding. Treatment with DOACs was stopped in three cases. The major reasons for choosing DOACs were no need for monitoring or inadequacy of INR to guide anticoagulation in cirrhotic patients. Renal and liver function did not change during treatment.
  
  
  
  A consistent number of patients with SVT and/or cirrhosis are currently treated with DOACs, which seem to be effective and safe. These data provide a basis for performing randomized clinical trials of DOACs vs. low molecular weight heparin or vitamin K antagonists.
authors: Hepatology, Department of Clinical Research and Clinic of Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.
authors: Andrea
authors: A
authors: De Gottardi
authors: University Hospital, Bonn, Germany.
authors: Jonel
authors: J
authors: Trebicka
authors: Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors: Christoph
authors: C
authors: Klinger
authors: DHU Unit, Hôpital Beaujon, Clichy-la-Garenne, France.
authors: Aurélie
authors: A
authors: Plessier
authors: King's College, London, UK.
authors: Susana
authors: S
authors: Seijo
authors: Epatocentro Ticino, Lugano, Switzerland.
authors: Benedetta
authors: B
authors: Terziroli
authors: Epatocentro Ticino, Lugano, Switzerland.
authors: Lorenzo
authors: L
authors: Magenta
authors: Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors: David
authors: D
authors: Semela
authors: Maggiore Hospital, Crema, Italy.
authors: Elisabetta
authors: E
authors: Buscarini
authors: CHIREC, Brussels, Belgium.
authors: Philippe
authors: P
authors: Langlet
authors: University Hospital, Bonn, Germany.
authors: Jan
authors: J
authors: Görtzen
authors: HUMV and Investigation Institute Marques de Valdecilla, Santander, Spain.
authors: Angela
authors: A
authors: Puente
authors: University Hospital, Zürich, Switzerland.
authors: Beat
authors: B
authors: Müllhaupt
authors: Hospital Universitario de Asturias, Oviedo, Spain.
authors: Carmen
authors: C
authors: Navascuès
authors: Hospital Santo Antonio, Porto, Portugal.
authors: Filipe
authors: F
authors: Nery
authors: CHUV, Lausanne, Switzerland.
authors: Pierre
authors: P
authors: Deltenre
authors: Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain.
authors: Fanny
authors: F
authors: Turon
authors: University Hospital Leipzig, Leipzig, Germany.
authors: Cornelius
authors: C
authors: Engelmann
authors: King's College, London, UK.
authors: Rupen
authors: R
authors: Arya
authors: Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors: Karel
authors: K
authors: Caca
authors: Medical University, Vienna, Austria.
authors: Markus
authors: M
authors: Peck-Radosavljevic
authors: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Frank W G
authors: FWG
authors: Leebeek
authors: DHU Unit, Hôpital Beaujon, Clichy-la-Garenne, France.
authors: Dominique
authors: D
authors: Valla
authors: Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain.
authors: Juan Carlos
authors: JC
authors: Garcia-Pagan
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005060:Europe; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D013152:Splanchnic Circulation / Q000502:physiology; D020246:Venous Thrombosis / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Budd-Chiari syndrome; anticoagulation; cirrhosis; portal vein thrombosis