Minireviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2022; 14(4): 682-695
Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.682
Direct oral anticoagulant administration in cirrhotic patients with portal vein thrombosis: What is the evidence?
Marco Biolato, Mattia Paratore, Luca Di Gialleonardo, Giuseppe Marrone, Antonio Grieco
Marco Biolato, Giuseppe Marrone, Antonio Grieco, Internal and Liver Transplant Medicine Unit, CEMAD, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Marco Biolato, Mattia Paratore, Luca Di Gialleonardo, Giuseppe Marrone, Antonio Grieco, Institute of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
Author contributions: Biolato M and Paratore M wrote the paper; Paratore M and Di Gialleonardo L performed literature analysis; Marrone G and Grieco A revised the paper for important intellectual content.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Biolato, MD, PhD, Staff Physician, Internal and Liver Transplant Medicine Unit, CEMAD, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, Rome 00168, Italy. marco.biolato@policlinicogemelli.it
Received: March 30, 2021
Peer-review started: March 30, 2021
First decision: July 27, 2021
Revised: September 22, 2021
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: April 27, 2022
Processing time: 388 Days and 3.5 Hours
Core Tip

Core Tip: The role of anticoagulant therapy in portal vein thrombosis is still unclear, especially in partial, chronic and asymptomatic thrombosis. Vitamin K antagonists and low-molecular-weight heparin were demonstrated to be safe and effective, with a positive influence on liver function, portal hypertension and mortality. Direct oral anticoagulants are a new approach to treat portal vein thrombosis in patients with cirrhosis and have many advantages compared to classic anticoagulants, although evidence is still limited. In patients awaiting liver transplantation, dabigatran may be promising for preventing thrombosis progression because of the low rate of hepatotoxicity, predominant renal metabolism and reversibility in perioperative management.