Use of nontraditional anticoagulants in portal vein thrombosis: A note of caution

Simonetto, Douglas A.; Wysokiński, Waldemar E.; Kamath, Patrick S.

doi:10.1002/hep.27541

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Recently, direct oral anticoagulants (DOACs) were approved for clinical use in indications different from PVT (ie, dabigatran, rivaroxaban, and apixaban). DOACs would offer the theoretical advantage of no need for laboratory monitoring . However, the experience with DOACs in patients with cirrhosis is very limited, and until more studies are available, they cannot be formally recommended for patients with cirrhosis.…”

Section: Management Of Portal Vein Thrombosis In Candidates For Livermentioning

confidence: 99%

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Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Chen¹,

Turón²,

et al. 2016

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Portal vein thrombosis (PVT) occurs in approximately 2%-26% of the patients awaiting liver transplantation (LT) and is no longer an absolute contraindication for LT. Nearly half of PVT cases are accidentally found during the LT procedure. The most important risk factor for PVT development in cirrhosis may be the severity of liver disease and reduced portal blood flow. Whether other inherited or acquired coagulation disorders also play a role is not yet clear. The development of PVT may have no effect on the liver disease progression, especially when it is nonocclusive. PVT may not increase the risk of wait-list mortality, but it is a risk factor for poor early post-LT mortality. Anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) are 2 major treatment strategies for patients with PVT on the waiting list. The complete recanalization rate after anticoagulation is approximately 40%. The role of TIPS to maintain PV patency for LT as the primary indication has been reported, but the safety and efficacy should be further evaluated. PVT extension and degree may determine the surgical technique to be used during LT. If a "conventional" end-to-end portal anastomotic technique is used, there is not a major impact on post-LT survival. Post-LT PVT can significantly reduce both graft and patient survival after LT and can preclude future options for re-LT. Liver Transpl 22:352-365, 2016. V C 2015 AASLD.

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Section: Management Of Portal Vein Thrombosis In Candidates For Livermentioning

confidence: 99%

“…DOACs would offer the theoretical advantage of no need for laboratory monitoring. [67][68][69] However, the experience with DOACs in patients with cirrhosis is very limited, 70 and until more studies are available, they cannot be formally recommended for patients with cirrhosis.…”

Section: Anticoagulationmentioning

confidence: 99%

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Chen¹,

Turón²,

et al. 2016

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“…Mild hepatic impairment did not seem to alter the pharmacokinetics of Rivaroxaban. However, moderate hepatic impairment significantly increased plasma levels (67).…”

Section: Experience With Pvtmentioning

confidence: 90%

Thrombotic Complications in Cirrhotic Patients: Balancing Risks and Benefits of Anticoagulation Treatment

Scărlătescu¹,

Mandell²,

Tomescu³

2016

JTMR

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The risk of excessive bleeding and thrombotic complications coexist in cirrhotic patients due to synthetic reduction in both pro and anticoagulants. However, investigators suggest the prevalence and consequences of thrombotic complications are underestimated. There is convincing evidence that thrombosis causes worsening portal hypertension, hepatic fibrosis and increases patient mortality. New evidence is emerging about the benefits of treating and preventing thrombotic complications in patients with liver disease. In the absence of welldesigned trials, clinical experience has become the most consistent guide to choose and dose anticoagulant drugs in this patient population. Practical use of anticoagulants however, is hindered by the lack of simple methods to monitor drug effect. In this review, we present a concise appraisal of current evidence on the most commonly studied indications for anticoagulation in cirrhotic patients. Information about drug action, dosing and monitoring are presented to provide a basis for clinical decision-making. The ongoing challenges in identifying therapeutic targets for treatment and monitoring drug effects are examined to highlight important clinical questions that have not yet been fully addressed.

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“…Several cases or case series reported the use of DOACs in these patients. 160,[202][203][204][205] The VALDIG study group recently reported results in 60 patients with NCPVT and 9 with BCS, some of whom also had cirrhosis, who were treated with DOACs. 206 They found a low rate of recurrent thrombosis and bleeding in 5% of patients, concluding that DOACs seemed safe and effective for individuals with NCPVT.…”

Section: Pnhmentioning

confidence: 99%

Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis

Hernández‐Gea

Gottardi

Leebeek

et al. 2019

Journal of Hepatology

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Budd-Chiari syndrome and non-cirrhotic non-tumoral portal vein thrombosis are 2 rare disorders, with several similarities that are categorized under the term splanchnic vein thrombosis. Both disorders are frequently associated with an underlying prothrombotic disorder. They can cause severe portal hypertension and usually affect young patients, negatively influencing life expectancy when the diagnosis and treatment are not performed at an early stage. Yet, they have specific features that require individual consideration. The current review will focus on the available knowledge on pathophysiology, diagnosis and management of both entities.

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Use of nontraditional anticoagulants in portal vein thrombosis: A note of caution

Cited by 8 publications

References 6 publications

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Thrombotic Complications in Cirrhotic Patients: Balancing Risks and Benefits of Anticoagulation Treatment

Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis

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