How to treat non-tumoral portal vein thrombosis in cirrhosis? Towards the use of direct-acting oral anticoagulants

2017 ◽  
Vol 2 ◽  
pp. 133-133
Author(s):  
Isabelle Ollivier-Hourmand ◽  
Aurélie Plessier
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Vein Thrombosis ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

scholarly journals Direct-Acting Oral Anticoagulants (DOACs) in Cirrhosis and Cirrhosis-Associated Portal Vein Thrombosis

2019 ◽  
Vol 39 (02) ◽  
pp. 195-208 ◽  
Author(s):  
Ethan Weinberg ◽  
Julia Palecki ◽  
K. Reddy
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Primary Prophylaxis ◽  
Current Treatment ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

AbstractDirect-acting oral anticoagulants (DOACs) have provided benefit in patients requiring anticoagulation for certain diseases by decreasing the burden of subcutaneous injections and the requirement for frequent monitoring through regular blood tests, to ensure adequacy of the therapeutic doses. Studies have demonstrated DOACs to be as safe, and in some instance safer, compared with traditional anticoagulants in the general population. However, the studies evaluating DOACs excluded patients with cirrhosis, a condition associated with an increased risk of developing portal vein thrombosis (PVT). Warfarin or low-molecular weight heparin are the standard-of-care treatment for acute PVT in cirrhosis, although there is enthusiasm in a paradigm shift switching to DOACs for the treatment of acute PVT in cirrhosis, particularly since the release of DOAC antidotes. This article reviews the current Food and Drug Administration-approved DOACs, hepatic metabolism of DOACs, pharmacokinetics of DOACs in patients with cirrhosis, safety of DOACs (including bleeding, hepatotoxicity, and pregnancy), current treatment guidelines for PVT in cirrhosis, and studies evaluating the use of DOACs in cirrhosis and for the treatment of PVT in cirrhosis. The potential use of DOACs for PVT primary prophylaxis in at-risk patients with cirrhosis and the possible antifibrotic effects of DOACs are also discussed.

scholarly journals Efficacy and Safety of Direct-Acting Oral Anticoagulants Use in Acute Portal Vein Thrombosis Unrelated to Cirrhosis

2017 ◽  
Vol 10 (2) ◽  
pp. 141-143 ◽  
Author(s):  
Filipe Nery ◽  
Diana Valadares ◽  
Sara Morais ◽  
Manuel Teixeira Gomes ◽  
Andrea De Gottardi
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Vein Thrombosis ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

scholarly journals The Natural History, Treatments, and Outcomes of Portal Vein Thrombosis in Patients With Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Leonard Naymagon ◽  
Douglas Tremblay ◽  
Nicole Zubizarreta ◽  
Erin Moshier ◽  
Steven Naymagon ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Bowel Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Vein Thrombosis ◽  
Inflammatory Bowel

Abstract Background Portal vein thrombosis (PVT) is a poorly described complication of inflammatory bowel disease (IBD). We sought to better characterize presentations, compare treatments, and assess outcomes in IBD-related PVT. Methods We conducted a retrospective investigation of IBD-related PVT at our institution. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios across treatments. Results Sixty-three patients with IBD-related PVT (26 with Crohn disease, 37 with ulcerative colitis) were followed for a median 21 months (interquartile ratio [IQR] = 9-52). Major risk factors included intra-abdominal surgery (60%), IBD flare (33%), and intra-abdominal infection (13%). Primary hematologic thrombophilias were rare and did not impact management. Presentations were generally nonspecific, and diagnosis was incidental. Ninety-two percent of patients (58/63) received anticoagulation (AC), including 23 who received direct oral anticoagulants (DOACs), 22 who received warfarin, and 13 who received enoxaparin. All anticoagulated patients started AC within 3 days of diagnosis. Complete radiographic resolution (CRR) of PVT occurred in 71% of patients. We found that DOACs were associated with higher CRR rates (22/23; 96%) relative to warfarin (12/22; 55%): the hazard ratio of DOACs to warfarin was 4.04 (1.83-8.93; P = 0.0006)). Patients receiving DOACs required shorter courses of AC (median 3.9 months; IQR = 2.7-6.1) than those receiving warfarin (median 8.5 months; IQR = 3.9-NA; P = 0.0190). Incidence of gut ischemia (n = 3), symptomatic portal hypertension (n = 3), major bleeding (n = 4), and death (n = 2) were rare, and no patients receiving DOACs experienced these adverse outcomes. Conclusions We show that early and aggressive use of AC can lead to excellent outcomes in IBD-associated PVT and that DOACs are associated with particularly favorable outcomes in this setting.

scholarly journals Newer Oral Anticoagulants in the Treatment of Acute Portal Vein Thrombosis in Patients with and without Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
P. Priyanka ◽  
J. T. Kupec ◽  
M. Krafft ◽  
N. A. Shah ◽  
G. J. Reynolds
Keyword(s):  
Molecular Weight ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Vitamin K ◽  
Low Molecular Weight Heparin ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Vein Thrombosis

Background. Newer oral anticoagulants (NOACs) are being utilized increasingly for the treatment of venous thromboembolism (VTE). NOAC use is the standard of care for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute VTE involving extremities and pulmonary embolism. In contrast, most guidelines in the literature support the treatment of acute portal vein thrombosis (PVT) with low molecular weight heparin (LMWH) and vitamin K antagonists (VKA). Literature evaluating NOAC use in the treatment of acute portal vein thrombosis is sparse. This review focuses on the safety and efficacy of the use of NOACs in the treatment of acute PVT in patients, with or without concomitant cirrhosis, based on the most recent data available in the current literature. Methods. A systematic review was conducted through a series of advanced searches in the following medical databases: PubMed, BioMed Central, Cochrane, and Google Scholar. Keywords utilized were as follows: NOAC, DOAC (direct oral anticoagulants), portal vein thrombosis, rivaroxaban, apixaban, dabigatran, and edoxaban. Articles related to newer anticoagulant use in patients with portal vein thrombosis were included. Results. The adverse events, including bleeding events (major and minor) and the failure of anticoagulation (propagation of thrombus or recurrence of PVT), are similar between the NOACs and traditional anticoagulants for the treatment of acute PVT, irrespective of the presence of cirrhosis. Conclusions. Newer oral anticoagulants are safe and efficacious alternatives to traditional anticoagulation with low molecular weight heparin and vitamin K antagonists in the treatment of acute portal vein thrombosis with or without cirrhosis.

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