Minireviews
Copyright ©The Author(s) 2019.
World J Gastroenterol. Aug 21, 2019; 25(31): 4437-4451
Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4437
Table 1 Reassessment between anti- and pro-hemostatic drivers in liver cirrhosis
Hemostasis phaseAnti-hemostatic driversPro-hemostatic drivers
Primary hemostasis (vasoconstriction and platelet plug formation)ThrombocytopeniaPlatelet hyperactivity High molecular weight multimers von Willebrand factor levels Low ADAM TS 13 levels and activity
Secondary hemostasis (coagulation cascades)Low anticoagulant factors levels: AT, protein C and S High procoagulant factor levels: factor VIIILow procoagulant factors levels: fibrinogen, factor II, V, VII, IX, X, XI
Tertiary hemostasis (fibrinolysis)Low plasminogen and high PAI levelsHigh t-PA levels Low TAFI and plasmin inhibitor levels
Table 2 Studies on direct oral anticoagulants efficacy and safety in cirrhotics with portal vein thrombosis
Ref.Study designNo. of patientsThrombosis extensionDrug and dosageDuration (mo)OutcomeBleeding complication
Martinez et al[80]Case report1Complete PVT+ SMVTUFH (BT) + rivaroxaban 20 mg daily6Complete recanalizationNo
Intagliata et al[81]Case series53 PVT, 2 PVT + SMVT2 Rivaroxaban 20 mg daily (1 VKA as BT) 3 Apixaban 2.5 mg twice daily1-7Complete recanalization (2 treated with rivaroxaban) Stable (1 treated with apixaban) Unkown (2 other cases)No
De Gottardi et al[82]Prospective22N/ARivaroxaban/Dabigatran/ Apixaban (60% VKA or LMWH as BT) mainly at lower dose14.6 (mean)N/A 1 recurrence of PVT with rivaroxaban1 major GI bleeding and 4 minor bleedings
Yang et al[83]Case report1PVTRivaroxaban 15 mg twice daily for 3 wk, then 20 mg daily6Complete recanalizationNo
Nagakoky et al[84]Prospective20PVTEdoxaban 30 mg daily (16) or 60 mg daily (4) (2 wk of danaparoid sodium as BT)6Partial recanalization3 major GI bleedings
Ponziani et al[85]Case report1PV and intrahepatic branches thrombosisAlready on rivaroxaban 20 mg daily treatment, then LMWHN/APortal cavernomaNo
Lenz et al[86]Case report1Partial PVTRivaroxaban 10 mg daily5Complete recanalization (recurrence after withdrawal)No
Qi et al[87]Case report1Occlusive SMVT SVTRivaroxaban 15 mg daily for 1 mo then 10 mg daily3PartialUpper GI bleeding
Pannach et al[88]Case report1PV and intrahepatic branches thrombosisRivaroxaban 20 mg dailyN/AResolutionNo