Direct Oral Anticoagulants in Patients with Liver Disease in the Era of Non-Alcoholic Fatty Liver Disease Global Epidemi
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REVIEW
Direct Oral Anticoagulants in Patients with Liver Disease in the Era of Non-Alcoholic Fatty Liver Disease Global Epidemic: A Narrative Review Stefano Ballestri . Mariano Capitelli . Maria Cristina Fontana . Dimitriy Arioli . Elisa Romagnoli . Catia Graziosi . Amedeo Lonardo . Marco Marietta . Francesco Dentali . Giorgio Cioni
Received: February 24, 2020 Ó The Author(s) 2020
ABSTRACT Atrial fibrillation (AF) and venous thromboembolism (VTE) are highly prevalent and relevant healthcare issues. Direct oral anticoagulants (DOACs) are now the first-choice for anticoagulant treatment of these conditions displaying a better efficacy/safety profile than vitamin-K antagonists, mainly due to significantly reduced risk of major bleeding, especially of intracranial haemorrhage. Nonalcoholic fatty liver disease Enhanced Digital Features To view digital features for this article go tohttps://doi.org/10.6084/m9.figshare. 11993394. S. Ballestri (&) M. Capitelli M. C. Fontana C. Graziosi G. Cioni Internal Medicine Unit, Pavullo Hospital, Azienda USL, Modena, Italy e-mail: [email protected] D. Arioli E. Romagnoli Internal Medicine and Critical Care Unit, Azienda Ospedaliero-Universitaria, Modena, Italy A. Lonardo Metabolic Syndrome Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria, Modena, Italy M. Marietta Hematology Unit, Azienda OspedalieroUniversitaria, Modena, Italy F. Dentali Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
(NAFLD) is the most common liver disease in developed countries showing a continuously growing prevalence. Nonalcoholic steatohepatitis (NASH), its evolutive form, will be the leading cause for liver transplantation by 2020. NAFLD is independently associated with an increased risk of abnormalities of cardiac structure and function, including cardiac rhythm disorders (mainly AF). Moreover, data suggest an increased risk of unprovoked VTE associated with NAFLD/NASH. Therefore, a growing number of patients with chronic liver disease (CLD) will be candidate for anticoagulant therapy in the near future. Cirrhosis of any etiology is characterized by an unstable thrombosis/bleeding haemostatic balance, making anticoagulant therapy particularly challenging in this condition. Given that patients with significant active liver disease and cirrhosis were excluded from all pivotal randomized controlled trials on DOACs, this comprehensive review aims at critically discussing real-world evidence, including the latest population studies, regarding the use of DOACs in patients with CLD/cirrhosis.
Keywords: Atrial fibrillation; Cardiovascular disease; Cirrhosis; Direct oral anticoagulants; Fatty liver; Heparin; Liver disease; Stroke; Thrombosis; Warfarin
Adv Ther
Key Summary Points Nonalcoholic fatty liver disease/ nonalcoholic steatohepatitis (NAFLD/ NASH), a globally epidemic condition, is independently associated with an increased risk of atrial fibrillation (AF) and unprovoked venous thromboembolism (VTE). Therefore, a growing mole of
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