Oral Anticoagulation in Patients With Liver Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:71

Review

Qamar, Arman¹  Vaduganathan, Muthiah²  Greenberger, Norton J.³  Giugliano, Robert P.¹ 

[1] Harvard Med Sch, Brigham & Womens Hosp, Cardiovasc Div, TIMI Study Grp, Boston, MA USA

[2] Harvard Med Sch, Brigham & Womens Hosp, Heart Vasc Ctr, Boston, MA USA

[3] Harvard Med Sch, Brigham & Womens Hosp, Gastroenterol Hepatol & Endoscopy Div, Boston, MA USA

关键词: anticoagulation;    atrial fibrillation;    bleeding;    liver disease;    thrombosis;    venous thromboembolism;   

DOI  :  10.1016/j.jacc.2018.03.023

来源: Elsevier

【 摘 要 】

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. (c) 2018 by the American College of Cardiology Foundation.

【 授权许可】

Free