Treatment of direct oral anticoagulants in patients with liver cirrhosis and portal vein thrombosis

Chun, Ho Soo; Choe, Alexander; Lee, Minjong; Cho, Yuri; Kim, Hwi Young; Yoo, Kwon; Kim, Tae Hun

doi:10.3350/cmh.2021.0109

Cited by 9 publications

(6 citation statements)

References 86 publications

(144 reference statements)

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“…The standard treatment for PVT in cirrhosis is vitamin K antagonist or low molecular weight heparin. With the introduction of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift toward using DOACs for the treatment of PVT in cirrhotic patients [ 26 ]. DOACs are useful for certain diseases by reducing the burden of subcutaneous injections and the need for frequent monitoring with regular blood tests to ensure adequate therapeutic doses.…”

Section: Reviewmentioning

confidence: 99%

Portal Vein Variations, Clinical Correlation, and Embryological Explanation: A Review Article

Tyagi¹,

Jha²

2023

Cureus

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Portal vein (PV) is a large vein that collects blood from the abdominal part of gall bladder, pancreas, alimentary tract, and spleen and transports to the liver. One of the parts of the extraembryonic venous system, the vitelline veins, is where PV starts. In about five weeks of gestation, a venous plexus is formed, and variations in this plexus lead to portal variance. The junction of superior mesenteric and splenic veins is typically where the vein begins to network. There are five types of branching patterns of the right PV: conventional branching, trifurcation branching, early branching, separate segment 7 branching, and separate segment 6 branching. To perform pancreatic, duodenal, and liver surgeries, knowledge of variations in PV formation is important. For surgical and interventional operations to be accurate, it is crucial to understand the architecture of the PV and its anomalies. As distinct regions of the brain connect with one another, portal architecture is frequently observed in imaging investigations. Portal hypertension is characterized as an increase in blood pressure in the portal venous system (PVS) in the context of severe liver disease, such as cirrhosis. Non-invasive methods for examining the anatomy and anomalies of the PV include ultrasound, computed tomography (CT), and magnetic resonance (MR). There are many abnormalities of PVS that have been discussed in the articles such as Congenital PV Absence; PV Branches Congenitally Grow in Structure; Hypoplasia, Atresia, and Stenosis of the PV; and Portosystemic Shunts.

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Section: Reviewmentioning

confidence: 99%

Portal Vein Variations, Clinical Correlation, and Embryological Explanation: A Review Article

Tyagi¹,

Jha²

2023

Cureus

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“…Для оцінки ефективності антикоагуляційного ефекту гепарину необхідний постійний моніторинг активованого часткового тромбопластинового часу, що обмежує застосування цієї схеми у відділенні інтенсивної терапії. Для амбулаторних пацієнтів доступні різноманітні варіанти, включаючи антагоністи вітаміну К (варфарин), низькомолекулярний гепарин, оральні прямі інгібітори фактора Ха (ривароксабан, апіксабан) та оральні прямі інгібітори тромбіну (дабігатран) [25,26].…”

Section: термінunclassified

The Surgeon's Perspective on Portal Vein Thrombosis in Patients With Liver Cirrhosis

Vasyliuk¹,

Gudyvok²,

Labiak³

et al. 2023

Scientific and practical journal

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The article discusses the key aspects of the etiology, diagnosis, and treatment of portal vein thrombosis in patients with liver cirrhosis. The prevalence of portal vein thrombosis in individuals with liver cirrhosis ranges from 0.6 % to 26 %, with a higher incidence observed in those with decompensated cirrhosis. Symptoms of portal vein thrombosis are often nonspecific. Approximately one-third of patients with this condition experience no symptoms, and the detection of a thrombus is usually an incidental finding during computed tomography or ultrasound examinations. Acute portal vein thrombosis is characterized by abdominal pain in the right upper quadrant, non-bloody diarrhea, or acute intestinal obstruction when there is symptomatic dilatation of the superior mesenteric vein. On the other hand, chronic portal vein thrombosis manifests through signs of portal hypertension, such as esophageal and gastric bleeding, deterioration of portal gastropathy, splenomegaly, pancytopenia, and significant ascites. The first-line treatment for portal vein thrombosis involves the use of direct and indirect anticoagulants. However, their administration necessitates careful consideration of the risk of intraluminal bleeding, the severity of cirrhosis, and the potential benefits of portal vein recanalization. Mechanical thrombectomy can serve as an alternative to long-term anticoagulant therapy for portal vein thrombosis. In cases of portal vein thrombosis in patients with cirrhosis, after mechanical thrombectomy and thrombolysis, the placement of transjugular intrahepatic portosystemic shunt (TIPS) is often performed. To conclude, portal vein thrombosis frequently occurs in patients with liver cirrhosis, and its appearance is challenging to predict due to its multifactorial nature. The preferred initial treatment for acute portal vein thrombosis, in the absence of intraluminal bleeding or intestinal ischemia, involves the use of direct and indirect anticoagulants. Minimally invasive surgical options, such as mechanical thrombectomy, chemical thrombolysis, and TIPS placement (with or without variceal embolization), are currently available. However, due to the heterogeneous nature of the existing data and the lack of randomized controlled trials, definitive recommendations regarding the optimal treatment strategy are not yet available. Keywords: cirrhosis, coagulopathy, portal hypertension, portal vein thrombosis, anticoagulants.

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“…The main conditions intended for determination of DOACs concentration in circulation may include the following clinical scenarios: before elective or urgent surgery or invasive procedures, in the case of adverse events (bleeding or thrombosis) during therapy, when making a decision on thrombolytic therapy in stroke patients, if suspicion of overdose or drug accumulation, when the need for the reversal of anticoagulation, when severe impaired renal function, if patients are taking other drugs known to affect the pharmacokinetics of DOACs, when extreme of body mass (< 50 kg and > 110 kg), in children (31)(32)(33). Further, despite the beneficial attributes of DOACs, monitoring the bleeding risk often represents a concern for clinicians prescribing DOACs, particularly in older patients (> 80 years old) and those with co-morbidities or taking other medications that may increase the risk of bleeding (34).…”

Section: Clinical Indications For Assessment Of Doacsmentioning

confidence: 99%

Direct oral anticoagulants (DOACs): From the laboratory point of view

et al. 2022

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Direct oral anticoagulants (DOACs) represent a new generation of drugs that have been increasingly used in the prevention and treatment of thromboembolic states. According to the mechanism of anticoagulant action, DOACs are divided into two groups: direct inhibitors of thrombin (dabigatran) and direct inhibitors of activated factor X (FXa) (rivaroxaban, apixaban, edoxaban, betrixaban). Compared to the vitamin K antagonists, DOACs are superior in terms of onset of action, pharmacokinetic and pharmacodynamics properties and fixed daily dose without the need for routine coagulation monitoring. Despite these advantages, there are clinical conditions in which laboratory measurement of DOACs should be performed. Although DOACs have an impact on screening haemostasis assays (prothrombin time, PT; activated partial thromboplastin time, aPTT; and thrombin time, TT), these tests are not appropriate for quantifying drug levels. Therefore, specific quantitative methods (LC-MS/MS as a gold standard method for all DOACs, coagulometric and chromogenic assays for dabigatran, and chromogenic anti-Xa assays with drug-specific calibrators for inhibitors of FXa) should only be used for determination of DOACs concentration. The aim of this review is to present all aspects of laboratory assessment of DOACs, including pre-analytical, analytical and post-analytical factors in the overall testing process with a special accent on the available specific quantitative methods for measurement of DOACs in circulation.

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Treatment of direct oral anticoagulants in patients with liver cirrhosis and portal vein thrombosis

Cited by 9 publications

References 86 publications

Portal Vein Variations, Clinical Correlation, and Embryological Explanation: A Review Article

Portal Vein Variations, Clinical Correlation, and Embryological Explanation: A Review Article

The Surgeon's Perspective on Portal Vein Thrombosis in Patients With Liver Cirrhosis

Direct oral anticoagulants (DOACs): From the laboratory point of view

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