Z Gastroenterol 2021; 59(08): e361
DOI: 10.1055/s-0041-1734316
POSTER
Hepatologie

Safety and efficacy of direct oral anticoagulants (DOACs) in Budd-Chiari Syndrome (BCS) - an Austrian multicenter study

G Semmler
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
,
L Balcar
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
,
A Lindorfer
3   Ordensklinikum Linz Barmherzige Schwestern, Department of Internal Medicine IV, Linz, Austria
,
S Bartl
4   Klinikum Wels-Grieskirchen, Department of Internal Medicine I, Wels, Austria
,
S Hametner-Schreil
3   Ordensklinikum Linz Barmherzige Schwestern, Department of Internal Medicine IV, Linz, Austria
,
S Gensluckner
5   Paracelsus Medical University Salzburg, First Department of Medicine, Salzburg, Austria
,
K Pomej
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
,
DJ Bauer
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
,
B Simbrunner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
6   Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
,
M Trauner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
,
H Hofer
4   Klinikum Wels-Grieskirchen, Department of Internal Medicine I, Wels, Austria
,
R Schöfl
3   Ordensklinikum Linz Barmherzige Schwestern, Department of Internal Medicine IV, Linz, Austria
,
E Aigner
5   Paracelsus Medical University Salzburg, First Department of Medicine, Salzburg, Austria
,
C Datz
7   General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Department of Internal Medicine, Oberndorf, Austria
,
M Mandorfer
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
,
T Reiberger
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
6   Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
,
B Scheiner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Vienna Hepatic Hemodynamic Lab, Vienna, Austria
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    Background and Aims In patients with Budd-Chiari Syndrome (BCS) long-term anticoagulation is recommended by current guidelines. Direct oral anticoagulants (DOACs) may simplify patient management due to lack of impact on INR/MELD and no need for monitoring such as with vitamin-K antagonists (VKAs). Here we report our experience with off-label use of DOACs for anticoagulation in BCS.

    Methods Efficacy and safety data of DOAC vs. VKA anticoagulant treatment was retrospectively assessed in 40 BCS patients treated at 5 Austrian centers.

    Results 38/40 patients were followed from initial BCS diagnosis while 2 patients were followed-up after orthotopic liver transplantation. Mean age at BCS diagnosis was 39.9±13.9years and median MELD 11(9-17). Overall, 60.5 %(23/38) had decompensated liver disease, and 84.2 %(32/38) showed signs of clinically significant portal hypertension (CSPH; n = 20 splenomegaly, n = 23 portosystemic collaterals/varices, n = 22 ascites, n = 2 variceal bleeding). 28.9 %(11/38) had splanchnic/portal vein thrombosis at initial presentation. During a median follow-up of 53 (17-128)months, 20 patients (50 %) received DOAC treatment (edoxaban:9, apixaban:4, rivaroxaban:4, dabigatran:2, sequential treatment:n = 1) for a median of 25 (7-45) months (history of decompensation: n = 15, clinical signs of CSPH: n = 17). 70 % (14/20) patients were switched from LMWH (n = 8) or VKA (n = 6) to DOAC after disease stabilization/improvement, while 30 %(6/20) of BCS patients were directly treated with DOAC. Complete response (EASL criteria) was achieved or maintained in 13/20(65 %) patients (including 3 patients receiving TIPS prior to DOAC initiation), ongoing response in 4 patients while disease progressed in 3 patients (including 2 patients with HCC). Three major bleedings (15 %) occurred during DOAC therapy (n = 2 upper-GI-bleeding, n = 1 HCC rupture), and 7 minor bleedings (n = 3 epistaxis, n = 2 oral cavity, n = 2 hypermenorrhea). Two deaths (n = 1 spontaneous bacterial peritonitis, n = 1 HCC) occurred while on DOAC therapy.

    Conclusion DOACs seem to be effective and safe for long-term anticoagulation in patients with BCS, but confirmation by larger prospective studies is needed.


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    Publication History

    Article published online:
    01 September 2021

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