Liver and Bile

Clin Gastroenterol Hepatol. 2023;21(4):978–87.e2

Semmler G, Lindorfer A, Schäfer B, Bartl S, Hametner-Schreil S, Gensluckner S, Balcar L, Pomej K, Lampichler K, Trauner M, Aigner E, Datz C, Zoller H, Hofer H, Schöfl R, Mandorfer M, Reiberger T, Scheiner B

Outcome of Budd-Chiari syndrome patients treated with direct oral anticoagulants: An Austrian multicenter study

Background and aims: Direct oral anticoagulants (DOACs) may simplify management of Budd-Chiari syndrome (BCS). Here, the authors report their experience with off-label use of DOACs for anticoagulation in BCS.
Methods: The safety of DOAC versus vitamin K antagonist treatment as well as associated clinical outcomes were retrospectively assessed in 47 BCS patients treated at 6 Austrian centers.
Results: Mean age at study inclusion was 37.9 ± 14.0 years and mean Model for End-stage Liver Disease (MELD) was 13.1 ± 5.1. Overall, 63.8% (n = 30) of patients had decompensated liver disease, and 87.2% (n = 41) showed clinical signs of portal hypertension. During a median follow-up of 82.5 (interquartile range [IQR], 43.1–121.8) months, 43 (91.5%) patients received anticoagulation alone or following interventional treatment, including 22 (46.8%) patients treated with DOACs (edoxaban: 10; apixaban: 4; rivaroxaban: 3; dabigatran: 3; > 1 DOAC sequentially: 2) for a median of 24.4 (IQR, 5.7–35.1) months. While 72.7% (n = 16/22) of patients were switched from low-molecular-weight heparin (n = 12) or vitamin K antagonist (n = 4) to DOAC after disease stabilization or improvement, 27.3% (n = 6/22) of BCS patients were initially treated with DOAC. Complete response (European Association for the Study of the Liver [EASL] criteria) was achieved or maintained in 14 (63.6%) of 22 patients, with ongoing response in 2 patients, while disease progressed in 6 patients (including 2 patients with hepatocellular carcinoma [HCC]). Four major spontaneous bleedings (18.2%; incidence rate = 8.8 per 100 patient-years; n = 2 upper gastrointestinal bleeding, n = 1 lower gastrointestinal bleeding, n = 1 HCC rupture), 7 minor bleedings, and 1 major procedure-related bleeding (4.5%; 2.2 per 100 patient-years) occurred during DOAC therapy. Overall transplant-free survival was 91.6% at 5 years.

Conclusions: Direct oral anticoagulants (DOACs) seem to be effective and safe for long-term anticoagulation in patients with Budd-Chiari syndrome, but confirmation by larger prospective studies is needed.

Prof. Dr. T. Reiberger, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,
E-Mail: thomas.reiberger@meduniwien.ac.at

DOI: 10.1016/j.cgh.2022.04.024

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Liver and Bile

Risk of liver fibrosis associated with long-term methotrexate therapy may be overestimated

J Hepatol. 2023;78(5):989–97

Liver and Bile

Model to predict major complications following liver resection for HCC in patients with metabolic syndrome

Hepatology. 2023;77(5):1527–39

Berardi G, Ratti F, Sposito C, Nebbia M, D’Souza DM, Pascual F, Dogeas E, Tohme S, D’Amico FE, Alessandris R, Simonelli I, Del Basso C, Russolillo N, Moro A, Fiorentini G, Serenari M, Rotellar F, Zimmitti G, Famularo S, Ivanics T, Hoffman D, Onkendi E, Essaji Y, Lopez Ben S, Caula C, Rompianesi G, Chopra A, Abu Hilal M, Torzilli G, Sapisochin G, Corvera C, Alseidi A, Helton S, Troisi RI, Simo K, Conrad C, Cescon M, Cleary S, Kwon CHD, Ferrero A, Ettorre GM, Cillo U, Geller D, Cherqui D, Serrano PE, Ferrone C, Mazzaferro V, Aldrighetti L, Kingham TP

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