Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2023; 15(6): 841-849
Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.841
Liver injury from direct oral anticoagulants
Deven Juneja, Prashant Nasa, Ravi Jain
Deven Juneja, Institute of Critical Care Medicine, Max Super Specialty Hospital, New Delhi 110017, India
Prashant Nasa, Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
Prashant Nasa, Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, United Arab Emirates
Ravi Jain, Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur 302001, Rajasthan, India
Author contributions: Nasa P conceptualized and designed the article; Juneja D, Nasa P, and Jain R performed acquisition of data, analysis and interpretation of data, and drafted the article; Juneja D and Jain R revised the article; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prashant Nasa, MD, Chief Doctor, Critical Care Medicine, NMC Specialty Hospital, Amman Street, Al Nahda 2, Dubai 7832, United Arab Emirates. dr.prashantnasa@gmail.com
Received: January 5, 2023
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

To determine the incidence, probability, and risk factors for developing DILI secondary to DOACs and its outcomes in affected patients.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.