DOACs use linked to bleeding in hepatocellular carcinoma: Study

The number of studies focussing on the effects of direct oral anticoagulants (DOACs) in patients with cirrhosis have been limited by their small sample size, the inclusion of patients with well-compensated cirrhosis, short follow-up times, inadequate validation of cirrhosis diagnoses, and non-standard definitions of bleeding.

A study was conducted by a group of researchers from Virginia, U.S.A to systematically determine the characteristics, indications, and outcomes of patients with cirrhosis of all severity classes who received direct oral anticoagulants (DOACs).

The authors performed a retrospective study of 138 patients with confirmed cirrhosis (93 with Child-Turcotte-Pugh scores of B or C) at a single center who started direct oral anticoagulants (DOAC) therapy from September 2011 through April 2019.

They collected data on clinical characteristics, indications for DOAC use, and outcomes. Standardized and validated definitions for bleeding complications were used.

The results of the study are as follows:

• 29 patients (21%) stopped therapy due to a diagnosis of or perceived bleeding.
• The most common bleeding events were non-variceal upper and lower intestinal bleeding.
• No pre-treatment laboratory parameters were associated with bleeding while patients received treatment, including platelet count international normalized ratio, creatinine, and model for end-stage liver disease score.
• Frequency of bleeding events related to DOAC did not differ significantly among patients of different Child-Turcotte-Pugh classes, DOAC indications, or DOAC dosages.
• Higher proportions of patients with hepatocellular carcinoma had major bleeding while receiving.

The researchers concluded that patients with decompensated cirrhosis have significant bleeding and rates of discontinuation of DOACs when they take them long term. Pre-treatment laboratory parameters, DOAC dose and Child-Turcotte-Pugh class were not associated with bleeding, but hepatocellular carcinoma was associated with major bleeding.

Reference:

Rates of Bleeding and Discontinuation of Direct Oral Anticoagulants in Patients with Decompensated Cirrhosis by Mort J et. al published in the Clinical Gastroenterology and Hepatology.

DOI: https://doi.org/10.1016/j.cgh.2020.08.007