Hum Justine, Shatzel Joseph J, Jou Janice H, Deloughery Thomas G
Department of Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Hematology, Knight Cancer Center, Oregon Health & Science University, Portland, OR, USA.
Eur J Haematol. 2017 Apr;98(4):393-397. doi: 10.1111/ejh.12844. Epub 2017 Jan 15.
The coagulopathy of cirrhosis is complex, placing patients at risk for both bleeding and thrombosis. Direct oral anticoagulants (DOACs) have equivalent or superior efficacy and safety as compared to vitamin K antagonists (VKAs); however, their efficacy and safety in liver cirrhosis has not been studied. To better define this, we evaluated outcomes of patients with cirrhosis prescribed DOACs compared to other anticoagulants at our center.
Retrospective cohort study of patients with cirrhosis prescribed therapeutic anticoagulation over a 3-year period for thrombosis or prevention of stroke in patients with atrial fibrillation. The primary outcomes of interest were bleeding events and recurrent thrombosis or stroke.
During the study period, 27 patients with cirrhosis were prescribed a DOAC and 18 were prescribed VKA or low molecular weight heparin (LMWH). Both groups had similar total bleeding events (8 DOAC vs 10 other, P=.12). There were significantly less major bleeding episodes in the DOAC group (1 [4%] vs 5 [28%], P=.03). Recurrent thrombosis occurred in one patient receiving a DOAC (4%) and one patient (6%) receiving other anticoagulation (P=1.0).
Direct oral anticoagulant use in patients with cirrhosis may be as safe as traditional anticoagulants. Patients with cirrhosis at our center prescribed DOACs had less major bleeding events, while maintaining efficacy at preventing stroke or thrombosis.
肝硬化的凝血病很复杂，使患者面临出血和血栓形成的风险。与维生素K拮抗剂（VKA）相比，直接口服抗凝剂（DOAC）具有同等或更高的疗效和安全性；然而，其在肝硬化中的疗效和安全性尚未得到研究。为了更好地明确这一点，我们评估了在我们中心使用DOAC的肝硬化患者与其他抗凝剂相比的治疗结果。
对在3年期间因血栓形成或预防房颤患者中风而接受治疗性抗凝的肝硬化患者进行回顾性队列研究。主要关注的结果是出血事件和复发性血栓形成或中风。
在研究期间，2名肝硬化患者被处方使用DOAC，18名患者被处方使用VKA或低分子肝素（LMWH）。两组的总出血事件相似（8例DOAC组 vs 10例其他组，P = 0.12）。DOAC组的严重出血事件明显较少（1例[4%] vs 5例[28%]，P = 0.03）。1例接受DOAC的患者（4%）和1例接受其他抗凝治疗的患者（6%）发生了复发性血栓形成（P = 1.0）。
肝硬化患者使用直接口服抗凝剂可能与传统抗凝剂一样安全。在我们中心，被处方使用DOAC的肝硬化患者严重出血事件较少，同时在预防中风或血栓形成方面保持疗效。
