Clin Mol Hepatol.
2021 Oct;27(4):535-552. 10.3350/cmh.2021.0109.
Treatment of direct oral anticoagulants in patients with liver cirrhosis and portal vein thrombosis
- Affiliations
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- 1Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- 2Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea
- 3Center for Liver and Pancreatobiliary Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- KMID: 2520836
- DOI: http://doi.org/10.3350/cmh.2021.0109
Abstract
- Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.
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