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Review
. 2024 Jan;39(6):169-176.
doi: 10.1159/000535438. Epub 2023 Dec 21.

The Challenge of Anticoagulation in Liver Cirrhosis

Julia Carolin Eichholz  1 , Heiner Wedemeyer  1   2   3   4 , Benjamin Maasoumy  1   5
Affiliations
Review

The Challenge of Anticoagulation in Liver Cirrhosis

Julia Carolin Eichholz et al. Visc Med. 2024 Jan.

Abstract

Background: Advanced liver diseases are characterized by a number of changes in the hemostatic system. Due to the occurrence of bleeding events in patients with liver cirrhosis, there seems to be a hesitance to the administration of anticoagulant medications. This review summarizes challenges, recommendations, and current developments of anticoagulation in the cirrhotic patient.

Summary: The risk of thrombotic events in patients with liver cirrhosis is at least as high as in patients with healthy liver function if not even higher. Standard laboratory markers do not truly reflect the complexity of changes that take place in the coagulative system and therefore cannot be used as a reference for risk of thrombosis or hemorrhage. Potential options for anticoagulant therapy are heparins, vitamin K antagonists, and direct-acting oral anticoagulants which come with differences in safety, application, possible side effects, and data availability for the patient cohort.

Key message: The administration of anticoagulation can be beneficial in patients with liver disease if the indication is present and bleeding prophylaxis has been established. Direct-acting oral anticoagulants appear to be a promising new approach with many improvements compared to conventional substances. Nevertheless, there is a need for further data and prospective trials on the use in patients with liver cirrhosis.

Keywords: Anticoagulation; Bleeding; Liver cirrhosis; Therapy; Thrombosis.

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Conflict of interest statement

J.C.E. has no conflicts to declare. H.W. and B.M. report financial funding from the German Center for Infection Research (DZIF) partner site Hannover-Braunschweig. H.W. serves as a speaker and/or consultant for AbbVie, Aligos Therapeutics, Altimmune, Astra Zeneca, Biotest AG, Bristol-Myers-Squibb, BTG Pharmaceuticals, Dicerna Pharmaceuticals, Eisai, Enanta Pharmaceuticals, Dr. Falk Pharma, Falk Foundation, Gilead, Intercept Pharmaceuticals, Janssen, Merck KGaA, MSD Sharp & Dohme GmbH, MYR GmbH, Norgine, Pfizer Pharma GmbH, Roche, and Vir Biotechnology. H.W. receives research grants from AbbVie, Biotest AG, and Gilead. B.M. serves as a consultant and speaker for MSD, Falk, AbbVie, Astellas, Fortbildungskolleg, Medical Tribune, Luvos, Roche, Norgine, Gilead, and Fujirebio and receives research funds from Fujirebio, Altona Diagnostics, Roche, and EWIMED. No other potential conflict of interest relevant to this article was reported.

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Grants and funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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