What are the side effects of direct oral anticoagulants during liver vascular disease?

Aims Given the potential severity of recurrent thrombosis and the high frequency of pro-thrombotic states in those patients, long-term anticoagulation may be necessary, however there are very few data on DOACs in this context. The aim of our work is to report our experience on the tolerance of DOACs.

Methods A prospective, descriptive, preliminary study of patients followed for liver vascular disease and put on on DOACs and who presented a side effect due to this therapy.

Results Of a total of 131 patients followed for liver vascular disease, 11% were on DOACs and 47% had an adverse event. All patients were followed up for Portal hypertension, where 29% for PSVD, portal cavernoma and Budd-Chiari syndromes regarding the Portal hypertension on HAI we got 14%. The associated conditions were protein S and C deficiency in all patients, one of whom was taking oral contraception at the same time (14%), and another with hyperhomocysteinemia due to celiac disease,All patients had preserved liver function. The average time of manifestation: 1 month. The following effects occurred: 43% of metrorrhagia, 29% for each of the following events: gingivorrhagia and hematemesis, one of which led to a state of hemorrhagic shock and then death, and 17% for each of the following events: rectorrhagia, melena, and epistaxis. Maintaining the same treatment for 43% of patients, temporarily stopping treatment for 14%, and switching to an AVK for 14%.

Conclusions DOACs are associated with many side effects, some of which are very severe. Although the few data in the literature are reassuring, especially in patients without liver dysfunction, more results are needed to recommend their use in practice.

Publication History

Article published online:
14 April 2023