Digestive Diseases and Sciences

, Volume 61, Issue 6, pp 1721–1727 | Cite as

Direct Oral Anticoagulants in Cirrhosis Patients Pose Similar Risks of Bleeding When Compared to Traditional Anticoagulation

  • N. M. IntagliataEmail author
  • Z. H. Henry
  • H. Maitland
  • N. L. Shah
  • C. K. Argo
  • P. G. Northup
  • S. H. Caldwell
Original Article


Background and Aims

Direct oral anticoagulants (DOAC) are important new anticoagulant therapies that are not well studied in patients with chronic liver disease. The aim of this study was to compare rates of bleeding in cirrhosis patients treated with DOAC (factor Xa inhibitors: rivaroxaban and apixaban) to those in cirrhosis patients treated with traditional anticoagulation (warfarin and low molecular weight heparin).


We identified a total of 39 patients with cirrhosis who received anticoagulation therapy over a 3-year period (20 DOAC and 19 traditional anticoagulation) from a research database. Medical records were reviewed to obtain clinical data to compare between the groups.


Clinical characteristics between the two groups were similar. There were three documented bleeding events in the traditional anticoagulation group and four bleeding events in the DOAC group (p = 0.9). There were two major bleeding events in the traditional anticoagulation group and one major bleeding event in the DOAC group. There were no documented reports of drug-induced liver injury during this study period. Among all patients, no significant predictors of bleeding were identified using univariate regression and Cox proportional hazard modeling.


This is the first clinical study evaluating the use of DOAC in patients with cirrhosis. DOAC display similar safety characteristics when compared to traditional anticoagulation in patients with cirrhosis and are potentially attractive agents for anticoagulation therapy. Larger studies are now needed to better understand the safety and efficacy of these agents in cirrhosis.


Coagulation Thrombosis Anticoagulation Bleeding Portal vein thrombosis DOAC Cirrhosis Factor Xa inhibitor 



Direct-acting anticoagulants


Venous thromboembolism


Vitamin K antagonists


Low molecular weight heparin


International normalized ratio




Model for end-stage liver disease


Intracranial hemorrhage


Prothrombin complex concentrates


Fresh frozen plasma


Compliance with ethical standards

Conflicts of interest

Z.H., C.A., and H.M. have nothing to disclose. N.I., N.S., and S.C. consulted for Vital Therapies. P.N. is consultant for Janssen Pharmaceuticals.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • N. M. Intagliata
    • 1
    Email author
  • Z. H. Henry
    • 1
  • H. Maitland
    • 2
  • N. L. Shah
    • 1
  • C. K. Argo
    • 1
  • P. G. Northup
    • 1
  • S. H. Caldwell
    • 1
  1. 1.Coagulation in Liver Disease Study Group, Division of Gastroenterology and HepatologyUniversity of Virginia Medical CenterCharlottesvilleUSA
  2. 2.Division of Hematology and OncologyUniversity of Virginia Medical CenterCharlottesvilleUSA

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