Direct-acting oral anticoagulants (DOACs) have provided benefit in patients requiring anticoagulation for certain diseases by decreasing the burden of subcutaneous injections and the requirement for frequent monitoring through regular blood tests, to ensure adequacy of the therapeutic doses. Studies have demonstrated DOACs to be as safe, and in some instance safer, compared with traditional anticoagulants in the general population. However, the studies evaluating DOACs excluded patients with cirrhosis, a condition associated with an increased risk of developing portal vein thrombosis (PVT). Warfarin or low-molecular weight heparin are the standard-of-care treatment for acute PVT in cirrhosis, although there is enthusiasm in a paradigm shift release of DOAC antidotes. This article reviews the current Food and Drug Administration-patients with cirrhosis, safety of DOACs (including bleeding, hepatotoxicity, and the use of DOACs in cirrhosis and for the treatment of PVT in cirrhosis. The potential use antifibrotic effects of DOACs are also discussed.
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