Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Switzerland.
Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Switzerland; Facoltà di Scienze Biomediche, Università Della Svizzera Italiana, Lugano, Switzerland.
Curr Opin Pharmacol. 2021 Oct;60:111-116. doi: 10.1016/j.coph.2021.07.006. Epub 2021 Aug 14.
Direct oral anticoagulants (DOACs) emerged as effective and safe alternatives to traditional anticoagulants for the prevention and treatment of venous thromboembolic disease and the prevention of stroke in non-valvular atrial fibrillation. Patients with advanced chronic liver disease (ACLD) have a higher risk of thromboembolism and bleeding than patients with normal liver function. Therefore, anticoagulation and, in particular, direct oral anticoagulants play a central role. Portal vein thrombosis is a relatively frequent complication in patients with ACLD, but its treatment remains challenging. DOACs have been introduced in clinical practice and demonstrated similar efficacy and safety profiles compared with vitamin K antagonist and heparins. However, further data about the use of DOACs in patients suffering from ACLD are needed. This review summarizes current knowledge in terms of anticoagulation in patients with ACLD and focuses on the available data about the use of DOACs in this population.
直接口服抗凝剂（DOACs）作为传统抗凝剂的有效且安全的替代品，已被用于预防和治疗静脉血栓栓塞疾病和预防非瓣膜性心房颤动中的中风。患有晚期慢性肝脏疾病（ACLD）的患者比肝功能正常的患者有更高的血栓栓塞和出血风险。因此，抗凝治疗，特别是直接口服抗凝剂，起着核心作用。门静脉血栓形成是 ACLD 患者中相对常见的并发症，但治疗仍然具有挑战性。DOACs 已在临床实践中引入，并显示出与维生素 K 拮抗剂和肝素相似的疗效和安全性。然而，需要更多关于 DOACs 在 ACLD 患者中使用的数据。这篇综述总结了 ACLD 患者抗凝治疗方面的现有知识，并重点介绍了有关该人群中使用 DOACs 的现有数据。
