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- Title
Safety of direct oral anticoagulants in patients with cirrhosis: a systematic review and meta-analysis.
- Authors
Lapumnuaypol, K; DiMaria, C; Chiasakul, T
- Abstract
Introduction Direct oral anticoagulants (DOACs) are effective treatment for venous thromboembolism. However, safety data in patients with cirrhosis are limited. We conducted a systematic review and meta-analysis to evaluate the safety of DOACs compared with warfarin or low-molecular weight heparin in patients with cirrhosis. Methods A systematic literature search was performed using MEDLINE and EMBASE from inception up to June 2018. We included prospective and retrospective studies involving adults ≥18 years with cirrhosis in whom anticoagulants were indicated for any indications. Primary outcome was all-cause bleeding events. Secondary outcome was major bleeding. Pooled risk ratio, pooled odd ratios and 95% confidence intervals (CIs) were calculated using random-effects model. Results Five studies with a total of 447 patients were included in the analysis. When compared with controls, the use of DOACs in cirrhotic patients did not show a significant difference in all-cause bleeding (risk ratio 0.72; 95% CI, 0.32–1.63). There was also no significant difference in major bleeding between both groups (odd ratio 0.46; 95% CI, 0.10–2.09). Conclusions Our study demonstrates that, compared to those who were treated with traditional anticoagulants, cirrhotic patients who were treated with DOACs had no significant increase risk of all-cause bleeding and major bleeding.
- Subjects
META-analysis; CIRRHOSIS of the liver; MEDICATION safety; ANTICOAGULANTS; HEMORRHAGE
- Publication
QJM: An International Journal of Medicine, 2019, Vol 112, Issue 8, p605
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hcz127