Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.841
Peer-review started: January 5, 2023
First decision: January 19, 2023
Revised: January 23, 2023
Accepted: May 15, 2023
Article in press: May 15, 2023
Published online: June 27, 2023
Processing time: 170 Days and 22.6 Hours
Drug-induced liver injury (DILI) can be caused by any prescribed drug and is a significant reason for the withdrawal of newly launched drugs. Direct-acting oral anticoagulants (DOACs) are non-vitamin K-based antagonists recently introduced and increasingly used for various clinical conditions. It is challenging to predict the risk factors for DILI in individual patients with exclusion of patients with pre-existing liver disease from these studies.
To determine the risk factors and outcomes of DILI in patients taking DOACs and provide clinicians with essential information for the management of DILI secondary to DOACs.
To determine the incidence, probability, and risk factors for developing DILI secondary to DOACs and its outcomes in affected patients.
The authors conducted a systematic search of multiple databases for the literature published in English using specific search terms. The results were filtered and analysed to determine the risk factors and outcomes of DILI in patients taking DOACs.
The analysis of recent case reports and series showed that DOACs can rarely cause DILI, and the incidence, probability, and risk factors for developing DILI varied among different DOACs.
DOACs can cause DILI, and the incidence, probability, and risk factors for developing DILI vary among different DOACs. Clinicians should have a high index of suspicion for DILI in patients taking DOACs, especially those with multiple risk factors. Prompt cessation of the suspected drug is recommended as the first step in managing DILI.
The findings of this study provide essential information for clinicians to manage DILI secondary to DOACs. However, further research is required to identify the true incidence of DILI and its risk factors, including genetic associations. Post-marketing pharmacovigilance reports can help to assess the risk of hepatoxicity associated with DOACs.