K Lapumnuaypol1, C DiMaria1, T Chiasakul2. 1. Department of Internal Medicine, Albert Einstein Medical Center, 5501 Old York road, Philadelphia, PA, USA. 2. Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Rd, Khwaeng Pathum Wan, Khet Pathum Wan, Krung Thep Maha Nakhon, Bangkok, Thailand.
Abstract
INTRODUCTION: Direct oral anticoagulants (DOACs) are effective treatment for venous thromboembolism. However, safety data in patients with cirrhosis are limited. We conducted a systematic review and meta-analysis to evaluate the safety of DOACs compared with warfarin or low-molecular weight heparin in patients with cirrhosis. METHODS: A systematic literature search was performed using MEDLINE and EMBASE from inception up to June 2018. We included prospective and retrospective studies involving adults ≥18 years with cirrhosis in whom anticoagulants were indicated for any indications. Primary outcome was all-cause bleeding events. Secondary outcome was major bleeding. Pooled risk ratio, pooled odd ratios and 95% confidence intervals (CIs) were calculated using random-effects model. RESULTS: Five studies with a total of 447 patients were included in the analysis. When compared with controls, the use of DOACs in cirrhotic patients did not show a significant difference in all-cause bleeding (risk ratio 0.72; 95% CI, 0.32-1.63). There was also no significant difference in major bleeding between both groups (odd ratio 0.46; 95% CI, 0.10-2.09). CONCLUSIONS: Our study demonstrates that, compared to those who were treated with traditional anticoagulants, cirrhotic patients who were treated with DOACs had no significant increase risk of all-cause bleeding and major bleeding.
INTRODUCTION: Direct oral anticoagulants (DOACs) are effective treatment for venous thromboembolism. However, safety data in patients with cirrhosis are limited. We conducted a systematic review and meta-analysis to evaluate the safety of DOACs compared with warfarin or low-molecular weight heparin in patients with cirrhosis. METHODS: A systematic literature search was performed using MEDLINE and EMBASE from inception up to June 2018. We included prospective and retrospective studies involving adults ≥18 years with cirrhosis in whom anticoagulants were indicated for any indications. Primary outcome was all-cause bleeding events. Secondary outcome was major bleeding. Pooled risk ratio, pooled odd ratios and 95% confidence intervals (CIs) were calculated using random-effects model. RESULTS: Five studies with a total of 447 patients were included in the analysis. When compared with controls, the use of DOACs in cirrhoticpatients did not show a significant difference in all-cause bleeding (risk ratio 0.72; 95% CI, 0.32-1.63). There was also no significant difference in major bleeding between both groups (odd ratio 0.46; 95% CI, 0.10-2.09). CONCLUSIONS: Our study demonstrates that, compared to those who were treated with traditional anticoagulants, cirrhoticpatients who were treated with DOACs had no significant increase risk of all-cause bleeding and major bleeding.
Authors: Patrick Manckoundia; Gilles Nuemi; Arthur Hacquin; Didier Menu; Clémentine Rosay; Jérémie Vovelle; Valentine Nuss; Camille Baudin-Senegas; Jérémy Barben; Alain Putot Journal: Int J Environ Res Public Health Date: 2021-04-22 Impact factor: 3.390
Authors: Trevor J Wilke; Bradley A Fremming; Brittany A Brown; Nicholas W Markin; Cale A Kassel Journal: J Cardiothorac Vasc Anesth Date: 2021-02-06 Impact factor: 2.628