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J Am Coll Cardiol. 2018 May 15;71(19):2162-2175. doi: 10.1016/j.jacc.2018.03.023.

Oral Anticoagulation in Patients With Liver Disease.

Author information

1
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
2
Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
3
Gastroenterology, Hepatology, and Endoscopy Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
4
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rgiugliano@partners.org.

Abstract

Patients with liver disease are at increased risks of both thrombotic and bleeding complications. Many have atrial fibrillation (AF) or venous thromboembolism (VTE) necessitating oral anticoagulant agents (OACs). Recent evidence has contradicted the assumption that patients with liver disease are "auto-anticoagulated" and thus protected from thrombotic events. Warfarin and non-vitamin K-antagonist OACs have been shown to reduce thrombotic events safely in patients with either AF or VTE. However, patients with liver disease have largely been excluded from trials of OACs. Because all currently approved OACs undergo metabolism in the liver, hepatic dysfunction may cause increased bleeding. Thus, the optimal anticoagulation strategy for patients with AF or VTE who have liver disease remains unclear. This review discusses pharmacokinetic and clinical studies evaluating the efficacy and safety of OACs in patients with liver disease and provides a practical, clinically oriented approach to the management of OAC therapy in this population.

KEYWORDS:

anticoagulation; atrial fibrillation; bleeding; liver disease; thrombosis; venous thromboembolism

PMID:
29747837
DOI:
10.1016/j.jacc.2018.03.023
[Indexed for MEDLINE]
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