Direct Oral Anticoagulants in Chronic Liver Disease

2019 ◽  
Vol 53 (10) ◽  
pp. 1042-1049 ◽  
Author(s):  
Taylor D. Steuber ◽  
Meredith L. Howard ◽  
Sarah A. Nisly
Keyword(s):  
Clinical Trials ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
English Language ◽  
Data Extraction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Chronic Liver ◽  
Venous Thromboembolic ◽  
The Individual

Objective: To review the use of direct oral anticoagulants (DOACs) in patients with chronic liver disease (CLD). Data Sources: A MEDLINE literature search was performed from 1964 through February 2019 using the following search terms: cirrhosis, chronic liver disease, direct oral anticoagulant, and the individual DOACs. Study Selection and Data Extraction: All English-language human trials and reports that examined DOACs for treatment or prevention of venous thromboembolic (VTE) events in patients with CLD were included. Data Synthesis: A total of 6 clinical trials examining the use of DOACs in patients with CLD were identified. All DOACs have been utilized in patients with CLD, with the exception of betrixaban, for prevention of stroke in atrial fibrillation or treatment of VTE (except for treatment of pulmonary embolism). The studies primarily evaluated patients with mild to moderate liver disease (Child-Turcotte-Pugh class A and B). The DOACs had similar rates of bleeding compared with traditional anticoagulants. Relevance to Patient Care and Clinical Practice: This review evaluates and summarizes the available evidence on DOACs in the setting of CLD. These agents may be more appealing in this population because monitoring or administration may be difficult with traditional anticoagulants (warfarin or low-molecular-weight heparins). Conclusion: Early data suggest that DOACs may be safe in patients with mild to moderate CLD. Should a DOAC be selected as an alternative to traditional anticoagulants, more frequent monitoring should be used because hepatotoxicity may be a concern. Larger clinical trials are needed to address efficacy outcomes as well as differences among individual DOACs in this population.

When and how to use direct oral anticoagulants in patients with advanced chronic liver disease?

2021 ◽  
Vol 60 ◽  
pp. 111-116
Author(s):  
Costanza De Maria ◽  
Antonio Galante ◽  
Alberto Fasoli ◽  
Andrea De Gottardi
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Chronic Liver

scholarly journals Clinical Trials in Chronic Liver Disease - What Do They Achieve?

2004 ◽  
Vol 18 (8) ◽  
pp. 489-492
Author(s):  
Jenny Heathcote
Keyword(s):  
Clinical Trials ◽  
Liver Disease ◽  
Drug Discovery ◽  
Pharmaceutical Industry ◽  
Chronic Liver Disease ◽  
Potential Benefit ◽  
Chronic Liver ◽  
The Past ◽  
Therapeutic Trials ◽  
The Individual

The past 30 years have seen rapid growth in the number of clinical trials in liver disease; due mostly to effective drug discovery programs by the pharmaceutical industry. The advantages associated with therapeutic trials in chronic liver disease, or any other disease for that matter, go far beyond potential benefit to the individual patient, other beneficiaries include the treating physician, the sponsoring agency and their investors, the institution/university and the general public. But there is always a downside to any experiment. The disadvantages and advantages of clinical trials in liver disease are the topics for this discussion.

scholarly journals Use of statins, amiodarone, direct oral anticoagulants and NSAIDs in chronic liver disease: a guide for general clinicians

2020 ◽  
Vol 58 (4) ◽  
pp. 181-187
Author(s):  
Sean Sileno ◽  
Razvan M. Chirila ◽  
Dana M. Harris
Keyword(s):  
Cardiovascular Disease ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Chronic Liver ◽  
Medical Problems ◽  
Cerebrovascular Accidents

AbstractPatients with chronic liver disease have associated comorbidities that require treatment, including cardiovascular disease, arrhythmias, cerebrovascular accidents and pain. These medications may affect the liver disease. Due to the complexity of medical problems in patients with chronic liver disease, treating clinicians benefit from targeted guidance for their care.

Extended-Duration Use of Direct Oral Anticoagulants to Prevent VTE in Acutely III Medical Patients

2019 ◽  
Vol 34 (2) ◽  
pp. 99-108
Author(s):  
Jessica W. Skelley ◽  
Angela R. Thomason ◽  
Lauren N. Hammond
Keyword(s):  
Clinical Trials ◽  
Human Subjects ◽  
Data Extraction ◽  
Oral Anticoagulants ◽  
Adult Population ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Medical Patients ◽  
Bleeding Events ◽  
Extended Duration

OBJECTIVE: To evaluate current clinical evidence for the use of direct oral anticoagulants (DOACs) for extended-duration thromboprophylaxis in the acutely ill medical population for venous thromboembolism (VTE) and bleeding events.<br/> DATA SOURCES: Were obtained through a MEDLINE/PubMed search for clinical trials conducted from March 2008 to 2018 using relevant key words. Limitations of English and human subjects were applied to search results.<br/> STUDY SELECTION AND DATA EXTRACTION: Forty-one articles were identified, and abstracts reviewed by the authors for inclusion of the study population (acutely ill medical patients) and VTE outcomes. Clinical studies evaluating the use of DOACs for extended duration of VTE prevention in acutely ill medical patients were included in the review, resulting in three clinical trials and two subgroup analyses. The participants enrolled had an overall mean age of 71.4 years.<br/> DATA SYNTHESIS: The DOAC trials collectively demonstrated a positive outcome in composite endpoints of VTE prevention with extended-duration thromboprophylaxis in acutely ill medical patients compared with enoxaparin. As for safety, rivaroxaban and apixaban trials reported more major bleeding events compared with enoxaparin. The betrixaban trial demonstrated no difference in bleeding compared with enoxaparin.<br/> CONCLUSION: DOACs reduced the number of VTE events in acutely ill medical patients on extended-duration thromboprophylaxis, but with an overall increased bleeding risk. An individualized patient approach based on risk factors should be utilized for treatment with extended-duration DOAC in the older adult population with recent hospitalization.

scholarly journals Autologous Bone Marrow Stem Cells in the Treatment of Chronic Liver Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Madhava Pai ◽  
Duncan Spalding ◽  
Feng Xi ◽  
Nagy Habib
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Clinical Trials ◽  
Stem Cell ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Adult Stem Cell ◽  
Bone Marrow Stem Cells ◽  
Chronic Liver ◽  
Major Advance

Chronic liver disease (CLD) is increasing worldwide yet there has been no major advance in effective therapies for almost five decades. There is mounting evidence that adult haematopoietic stem cells (HSC) are capable of differentiating into many types of tissue, including skeletal and cardiac muscle, neuronal cells, pneumocytes and hepatocytes. These recent advances in regenerative medicine have brought hope for patients with liver cirrhosis awaiting transplantation. New findings in adult stem cell biology are transforming our understanding of tissue repair raising hopes of successful regenerative hepatology. Although all clinical trials to date have shown some improvement in liver function and CD34+cells have been used safely for BM transplantation for over 20 years, only randomised controlled clinical trials will be able to fully assess the potential clinical benefit of adult stem cell therapy for patients with CLD. This article focuses on the potential of bone marrow stem cells (BMSCs) in the management of CLD and the unresolved issues regarding their role. We also outline the different mechanisms by which stem cells may impact on liver disease.

scholarly journals Pharmacogenetics of Direct Oral Anticoagulants

2021 ◽  
Author(s):  
Natalia Shnayder ◽  
Marina Petrova ◽  
Elena Bochanova ◽  
Olga Zimnitskaya ◽  
Alina Savinova ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Pharmacokinetic Profile ◽  
Thrombin Inhibitor ◽  
Oral Vitamin ◽  
Treatment And Prevention ◽  
Venous Thromboembolic ◽  
The Individual

For more than 50 years, oral vitamin K antagonists were the choice of anticoagulant for the long-term treatment and prevention of arterial and venous thromboembolic events. In recent years, four direct oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban and edoxaban have been compared with warfarin for thromboembolism prevention. These anticoagulants directly inhibit specific proteins within the coagulation cascade; in contrast, oral vitamin K antagonists inhibit the synthesis of vitamin K-dependent clotting factors. Dabigatran, a direct thrombin inhibitor, and rivaroxaban, apixaban and edoxaban, the factor Xa inhibitors, produce a more predictable, less labile anticoagulant effect. DOACs do not have limitations inherent vitamin K antagonists. DOACs have a predictable pharmacokinetic profile and are free of advers drugs reactions inherent in vitamin K antagonists. However, it is necessary to take into account the pharmacogenetic characteristics of the individual that can affect effectiveness and safety of use of DOACs. The results carried out to the present fundamental and clinical studies of DOACs studies demonstrate an undeniable the influence of genome changes on the pharmacokinetics and pharmacodynamics of DOACs. However, the studies need to be continued. There is a need to plan and conduct larger studies in various ethnic groups with the inclusion of sufficient associative genetic studies of the number of patients in each of the documented groups treatments with well-defined phenotypes.

Andexanet alfa: A Novel Factor Xa Inhibitor Reversal Agent

2019 ◽  
Vol 53 (9) ◽  
pp. 940-946 ◽  
Author(s):  
Jason Powell ◽  
James Taylor ◽  
Scott G. Garland
Keyword(s):  
Clinical Practice ◽  
English Language ◽  
Data Extraction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Clinical Trial Data ◽  
Trial Data ◽  
Reversal Agent ◽  
Fda Approval ◽  
Andexanet Alfa

Objective: The purpose of this article is to review the available clinical trial data for andexanet alfa and its role in clinical practice. Data Sources: A MEDLINE/PubMed search was conducted (January 2000 to January 2019) using the keyword andexanet alfa for clinical trials. References of identified articles were searched by hand for additional citations. Study Selection and Data Extraction: We included English-language articles related to the Food and Drug Administration (FDA) approval of andexanet alfa or provided novel information regarding this drug entity. Data Synthesis: The findings of the review show that andexanet alfa may be a safe and effective option for the reversal of apixaban and rivaroxaban. Relevance to Patient Care and Clinical Practice: With the approval of this reversal agent, patients and providers can feel safer when using apixaban and rivaroxaban, which in turn may increase the use of these anticoagulant agents. Conclusions: The new FDA approval of andexanet alfa will allow safer use of oral anticoagulants and will likely further the use of direct oral anticoagulants for anticoagulant needs. Reversing enoxaparin-/edoxaban-induced bleeding with this agent should be limited because there is no FDA approval owing to the fact that only phase II trial data available.

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