LP11 : Warfarin anticoagulation for liver fibrosis in patients transplanted for hepatitis C (WAFT-C): results at one year

Dhar, Ameet; Tschotazis, E.; Brown, Richard; Manousou, Pinelopi; Millson, C; Aldersley, M.; Forbes, Shareen; Aggarwal, Kamal; Gera, A; Cramp, Matthew; Holt, Andrew; Mutimer, David; McPherson, Stuart; Burroughs, Andrew K.; Anstee, Quentin M.; Goldin, Robert; Thursz, Mark

doi:10.1016/s0168-8278(15)30165-3

Cited by 17 publications

(9 citation statements)

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“…An interesting phase II study undergoing in the UK is evaluating the efficacy of anticoagulation with warfarin for prevention of fibrosis in liver transplant (LT) patients with recurrent HCV-infection [ 49 ]. The interim analysis showed a significant reduction of fibrosis 1 year after LT in anticoagulated patients.…”

Section: Clinical Studiesmentioning

confidence: 99%

The Role of Anticoagulation in Treating Portal Hypertension

Turco

Schepis

Villa

2018

Curr Hepatology Rep

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Purpose of ReviewTo revise experimental and clinical data supporting a less traditional role of anticoagulation for treating portal hypertension in patients with cirrhosis.Recent FindingsPortal hypertension is the main driver of complications such as ascites, variceal hemorrhage, and hepatic encephalopathy, with inflammation as a key component. The traditional view of cirrhosis as a pro-hemorrhagic condition has recently changed, prothrombotic complications being recognized as frequently as the hemorrhagic ones. Several data indicate a close relationship between inflammation, prothrombotic status, worsening of hepatic fibrosis, and portal hypertension both in animal models and in patients with chronic liver disease. These findings indicate that anticoagulation may represent a potent tool to act on fibrogenesis and therefore consequently to treat portal hypertension. All anticoagulants have good to optimal safety profiles and can be used in patients with advanced chronic liver disease with confidence.SummaryAnticoagulation has a role as a pleiotropic treatment of portal hypertension in cirrhosis.

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Section: Clinical Studiesmentioning

confidence: 99%

The Role of Anticoagulation in Treating Portal Hypertension

Turco

Schepis

Villa

2018

Curr Hepatology Rep

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“…A reduction in fibrosis scores at one year post-OLT in patients treated with warfarin was demonstrated, compared to patients not taking anticoagulation; completion of this study is awaited to validate these findings. (34) Finally, no increased risk of bleeding was reported in an abstract of preliminary results of this study.…”

Section: The State Of the Hemostatic System In Cldmentioning

confidence: 69%

Hemostatic System in Chronic Viral Hepatitis

Борисова¹,

Popova²,

Sleptsovа³

et al. 2018

IJBM

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Hemostasis is balanced by pro-and anticoagulant and pro-and antifibrinolytic factors, most of these being synthesized by the liver. Advanced liver disease is associated with perturbations in the level of these factors due to secretory deficiencies. Thrombocytopenia, reduced levels of factor II-VII-X, and anti-fibrinolytic factors are all features of CHC infection, suggesting hypocoagulability. However, higher concentrations of VWF and factor VIII, as well as lower concentrations of anticoagulant factors including protein C and S, have also been reported in CHC infections, suggesting hypercoagulability. Thus, the hemostatic balance in the patient with liver disease is relatively unstable as evidenced by the occurrence of both bleeding and thrombotic complications in a significant proportion of patients with chronic viral hepatitis. In patients with chronic liver disease (CLD), in whom extremely complex alterations of hemostasis occur, one cannot rely on levels of individual coagulation factors, or on simplified tests of hemostasis such as the PT or APTT to predict the hemostatic status. To determine the hemostatic status in these patients, more complex tests and a more comprehensive overview of the hemostatic changes are required. In connection with the latest studies, a revision of the methods for correction of hemostatic system disorders in patients with acute and chronic liver diseases becomes urgent.

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“… 40 In complementary observational studies, patients with hepatitis C cirrhosis having elevated prothrombin levels or factor V Leiden disease have been found to have higher fibrosis levels than controls. 41 , 42 Furthermore, prior studies in animal models 43 – 47 and humans 13 , 48 suggest AC may have an antifibrinogenic effect and potentially modify the course of chronic liver disease. 5 , 39 In particular, administration of LMWH reduced fibrosis in multiple rat models of liver injury, 43 , 44 while use of both VKA 45 and factor Xa inhibitor 46 reduced fibrogenesis in murine models.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis

Davis

Ogurick

Rothermel

et al. 2019

Clin Appl Thromb Hemost

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Portal vein thromboses (PVTs) are associated with hepatic decompensation, worse survival, and worse liver transplant outcomes. We evaluated the impact of anticoagulation (AC) and transjugular intrahepatic portosystemic shunting (TIPS) on recanalization and mortality in patients with cirrhosis and PVT. Systematic search of electronic databases was performed. Clinical trials and observational studies that evaluated primary outcomes of recanalization and survival in patients with cirrhosis having PVT treated with AC or TIPS were included. Risk of bias was assessed. Summary odds ratios (ORs) for pooled data from the included studies were generated using a random effects model. A total of 505 studies were screened for inclusion. After review, 7 studies were ultimately included. Data from 327 patients in total were evaluated. Overall, treatment with either AC or TIPS resulted in partial or complete recanalization (OR: 4.56 [95% confidence interval, CI: 2.46-8.47]) but did not significantly impact mortality (OR: 0.57 [95% CI: 0.21-1.57]). The summary OR of AC for recanalization was 6.00 (95% CI: 2.38-15.07). The summary OR of TIPS for recanalization was 3.80 (95% CI: 1.47-9.83). The summary OR of mortality in patients treated with AC for PVT was 0.28 (95% CI: 0.08-0.95). The mortality summary OR was 1.10 (95% CI 0.23-5.16) in patients who underwent TIPS. There was insufficient data to assess complications such as hepatic encephalopathy or bleeding. Both AC and TIPS have a significant effect on recanalization. Anticoagulation appears to have a protective effect on mortality that is not seen with TIPS. More studies with control groups are need.

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LP11 : Warfarin anticoagulation for liver fibrosis in patients transplanted for hepatitis C (WAFT-C): results at one year

Cited by 17 publications

References 0 publications

The Role of Anticoagulation in Treating Portal Hypertension

The Role of Anticoagulation in Treating Portal Hypertension

Hemostatic System in Chronic Viral Hepatitis

Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis

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