Objectives: To compare whole body and regional (arms, legs and trunk) fat mass, fat-free mineral-free mass, bone mineral content and bone mineral density, measured by DXA, in cirrhotic patients and age, sex and BMI matched healthy volunteers. Design: Cross-sectional study. Setting: Two medical research institutions. Subjects: Twenty-two non ascitic cirrhotic patients and 16 age, sex and BMI matched healthy volunteers. Interventions: The Lunar DPX whole-body X-ray densitometer with Lunar software version 3.6z (Lunar Radiation Corp., Madison WI, USA) was used. Regional analysis was performed on the arms, legs, trunk and head. Results: Compared to controls, cirrhotic patients showed a signi®cant reduction in percentage body fat. When differentiated by gender, however, the reduction in percentage body fat was evident in female cirrhotics only, particularly in the trunk. In male cirrhotic patients fat-free mineral-free mass was reduced in absolute terms in the whole body and the limbs. For both genders and in each body segment bone mineral content and density were reduced in cirrhotics compared to controls. In cirrhotic patients bone mineral density was signi®cantly correlated to both fat-free, mineral-free mass (r 0.85; P`0.001) and to the Physical Activity Index (r 0.52; P`0.01). Conclusions: Two different patterns of soft tissue loss may be found in cirrhotic patients: in women lean tissue is maintained while fat stores are reduced, as in early starvation; in men lean tissue is reduced, as seen under conditions of stress. Moreover, factors in¯uencing lean body mass, such as nutritional depletion and physical inactivity, may contribute to the reduction of bone density frequently observed in cirrhotic patients. Sponsorship: This work has been funded by the University of Rome,`La Sapienza' research grant MURST 60%, 1995.

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Background Splanchnic vein thrombosis (SVT) is an uncommon but potentially life‐threatening disease usually related to different underlying clinical conditions. The risk of SVT recurrences is high over time in patients with an underlying permanent prothrombotic condition. Vitamin K antagonists (VKA) represent the mainstay of treatment for SVT. Data about the efficacy and safety of direct oral anticoagulants (DOACs) are reported in the literature for the treatment of acute SVT, but less is known about their application for the secondary prophylaxis of venous thromboembolism (VTE). The aim of this study was to assess the efficacy and safety of long‐term DOACs therapy in patients at high‐risk of thrombosis, compared to VKA. Methods This is a retrospective single‐centre study including 70 patients with SVT on long‐term anticoagulant treatment with VKA followed‐up at our Units between January 2017 and December 2019. All the patients were at high thrombotic risk defined as the presence of a permanent prothrombotic condition requiring long‐term anticoagulation. During follow‐up, 28 patients were shifted to DOACs and their clinical outcomes were compared to those of the patients who continued VKA therapy. All the arterial and venous thrombotic events of the splanchnic and extra‐splanchnic districts as well as the haemorrhagic adverse events occurring during follow‐up were recorded. Results Of the seventy patients enrolled in the study, 36 patients (51.4%) had a single‐segment involvement thrombosis (28.5% of portal vein, 7.1% of superior mesenteric vein, 4.3% of splenic vein, 11.5% of hepatic veins) and 34 patients (48.6%) had multi‐segment involvement at the time of diagnosis. 42 patients (60%) continued VKA therapy and 28 (40%) were switched to DOACs. Median follow‐up was 6 years (range 2‐8) during VKA and 1.9 years (range 1‐5.2) during DOACs. The incidence of thrombotic events was similar between patients on VKA and those on DOACs. Patients on VKA developed deep vein thrombosis (DVT), and of the patients on DOACs 1 developed NSTEMI and 1 DVT. No major haemorrhagic events occurred. Minor bleedings occurred in 26% of patients on VKA and in none of the DOACs patients (P: 0.09). Conclusions Our results highlight that DOACs could represent an effective and safe alternative to the VKA for secondary prophylaxis in SVT patients at high risk of thrombosis.

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