Direct oral anticoagulant administration in cirrhotic patients with portal vein thrombosis: What is the evidence?

Table 1 Safety of direct oral anticoagulants in cirrhosis

Ref.	Drug administrated (n of patients)	Child-Pugh score at baseline	Indication for anticoagulant therapy	Definition of events	Events in cases vs control
Ai et al[87]	Rivaroxaban 20 mg once daily (26 pts)	Mean 7.2	PVT	No definition of events	3 vs 1 (P = 0.616); 1 hematuria in dabigatran; 1 hemoptysis in rivaroxaban; 1 melena in rivaroxaban
	Dabigatran 150 mg twice daily (14 pts)
	No anticoagulant (40 pts)	Mean 7.4
Hanafy et al[88]	Rivaroxaban 10 mg twice daily (40 pts)	Mean 6.4	PVT	Major bleeding	0 vs 17 (P = 0.001)
	Warfarin (40 pts)	Mean 6.2		Death bleeding related	0 vs 8 (P = 0.001)
Nagaoki et al[89]	Edoxaban 60 mg or 30 mg once daily (20 pts)	Child-Pugh A; (15 pts); Child-Pugh B; (5 pts)	PVT	Adverse events of grades 3/4 according to Common Terminology Criteria for Adverse Events version 4.0	3 vs 2 (P = 0.335)
	Warfarin (30 pts)	Child-Pugh A; (15 pts); Child-Pugh B; (10 pts); Child-Pugh C; (5 pts)
De Gottardi et al[83]	Rivaroxaban (30 pts); Dabigatran (4 pts); Apixaban (2 pts)	Mean 6	PVT (22 pts); Budd Chiari syndrome (5 pts); Cardiac Arrhythmia (5 pts); DVT (2 pts); Other (2 pts)	Major bleeding	1
				Minor bleeding	4
Intagliata et al[84]	Apixaban 5 mg or 2.5 mg twice daily or; Rivaroxaban 20 mg or 10 mg daily (20 pts)	Child A; (9 pts); Child B; (11 pts)	PVT (12 pts); Non-splanchnic VTE (4 pts); Atrial fibrillation (4 pts)	Major bleeding	1 vs 2 (P = 0.6)
	LMWH or VKA (19 pts)	Child A (9 pts); Child B (10 pts)		Moderate bleeding	1 vs 1
				Mild event	2 vs 1
Hum et al[85]	Rivaroxaban 15 mg daily (17 pts); Apixaban 5 mg twice daily (10 pts)	Child A; (11 pts); Child B; (12 pts); Child C; (4 pts)	PVT (4 pts); DVT (12 pts); Atrial fibrillation (15 pts)	Major bleeding	1 vs 5 (P = 0.03)
	LMWH or WKA (18 pts)	Child A; (7 pts); Child B; (9 pts); Child C; (2 pts)		Moderate bleeding	4 vs 5 (P = 0.45)
				Mild bleeding	3 vs 0 (P = 0.26)
Goriacko et al[91]	Dabigatran (35 pts); Rivaroxaban (29 pts); Apixaban (11 pts)	Child A; (48 pts); Child B; (26 pts); Child C; (1 pts)	Atrial fibrillation	Major bleeding	3.3% vs 3.9% (P = No significance)
	Warfarin (158)	Child A; (56 pts); Child B; (93 pts); Child C; (9 pts)

PVT: Portal vein thrombosis; DVT: Deep vein thrombosis; VTE: Venous thromboembolism; LMWH: Low molecular weight heparin; VKA: Vitamin K antagonist.