Efficacy and safety of edoxaban for treatment of portal vein thrombosis following danaparoid sodium in patients with liver cirrhosis

Abstract

Aim:To compare the efficacy and safety of edoxaban and warfarin for treatment of portal vein thrombosis (PVT) following danaparoid sodium in patients with liver cirrhosis.Methods: Fifty cirrhotic patients with PVT treated initially for 2 weeks with danaparoid sodium were enrolled in this retrospective cohort study. Treatment was later switched to either edoxaban (n = 20) or warfarin (n = 30). We compared the efficacy and safety of edoxaban and warfarin for up to 6 months. The PVT volume was measured by dynamic computed tomography before treatment, at 2 weeks, and at 1, 3, and 6 months.

Clinical implications of CT findings in mesenteric venous thrombosis at admission

“…Furthermore, the changes in thrombotic status were assessed by a semi-quantitative ordinal scale between CT examinations. With a prospective study design, a more modern quantitative evaluation using computer software for automatical or semi-automatical measurements of differences in thrombus volume [17] might be possible. Furthermore, appropriate statistical adjustment for several confounding variables in multi-variable analysis was not possible in our study, despite a rather large cohort of patients with MVT.…”

Recent developments in the field of vascular liver diseases

“…Although the use of direct oral anticoagulants for Budd‐Chiari syndrome and portal vein thrombosis is rapidly increasing, studies remain limited if not anecdotal. Indeed, the small numbers of patients in studies evaluating Budd‐Chiari syndrome, recent portal vein thrombosis and portal cavernoma in the absence of cirrhosis, and portal vein thrombosis in patients with cirrhosis, prevents drawing any conclusions and making any recommendations. Experience is increasing in patients with cirrhosis without splanchnic vein thrombosis but with other indications (mostly atrial fibrillation) .…”

“…Since this paper was published, a dozen, mainly retrospective studies have been published, largely confirming these findings in a total of 653 patients receiving anticoagulation, and including 312 patients who received anticoagulants compared to 251 patients who did not. [28][29][30][31][32]35,[64][65][66][67] These recent studies show the high risk of recurrence following discontinuation of anticoagulation (43% in 219 patients at risk). Even more interestingly, these studies provide data on additional points that are important for the interpretation of mainly morphological data.…”

Portal Vein Thrombosis Prediction: Rebalanced Coagulation and Rethinking Anticoagulation

“…Finally, warfarin is an unattractive anticoagulation option given its narrow therapeutic window, long half-life, lack of a reversal agent, reliance on INR, and inferior efficacy. (8,9) However, the best type and optimal dose of anticoagulation in patients with cirrhosis remains unclear. With numerous direct oral anticoagulants available for use at prophylactic and therapeutic dosages, some with lower risk for bleeding than others, there is an urgent need to undertake further study of these medications in patients with cirrhosis both as prophylaxis and as treatment.…”

“…Finally, warfarin is an unattractive anticoagulation option given its narrow therapeutic window, long half‐life, lack of a reversal agent, reliance on INR, and inferior efficacy . However, the best type and optimal dose of anticoagulation in patients with cirrhosis remains unclear.…”