Liver injury from direct oral anticoagulants  

作　　者：Deven Juneja Prashant Nasa Ravi Jain 

机构地区：[1]Institute of Critical Care Medicine,Max Super Specialty Hospital,New Delhi 110017,India [2]Critical Care Medicine,NMC Specialty Hospital,Dubai 7832,United Arab Emirates [3]Internal Medicine,College of Medicine and Health Sciences,Al Ain 15551,United Arab Emirates [4]Critical Care Medicine,Mahatma Gandhi Medical College and Hospital,Jaipur 302001,Rajasthan,India

出　　处：《World Journal of Hepatology》2023年第6期841-849,共9页世界肝病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Drug-induced liver injury(DILI)can be caused by any prescribed drug and is a significant reason for the withdrawal of newly launched drugs.Direct-acting oral anticoagulants(DOACs)are non-vitamin K-based antagonists recently introduced and increasingly used for various clinical conditions.A meta-analysis of 29 randomised controlled trials and 152116 patients reported no increased risk of DILI with DOACs.However,it is challenging to predict the risk factors for DILI in individual patients with exclusion of patients with pre-existing liver disease from these studies.AIM To determine the risk factors and outcomes of patients who developed DILI secondary to DOACs by systematic review and meta-summary of recent case reports and series.METHODS A systematic search was conducted on multiple databases including PubMed,Science Direct,Reference Citation Analysis,and Google Scholar.The search terms included“Acute Liver Failure”OR“Acute-On-Chronic Liver Failure”OR“Acute Chemical and Drug Induced Liver Injury”OR“Chronic Chemical and Drug Induced Liver Injury”AND“Factor Xa Inhibitors”OR“Dabigatran”OR“Rivaroxaban”OR“apixaban”OR“betrixaban”OR“edoxaban”OR“Otamixaban”.The results were filtered for literature published in English and on adult patients.Only case reports and case studies reporting cases of DILI secondary to DOACs were included.Data on demographics,comorbidities,medication history,laboratory investigations,imaging,histology,management,and outcomes were extracted.RESULTS A total of 15 studies(13 case reports and 2 case series)were included in the analysis,comprising 27 patients who developed DILI secondary to DOACs.Rivaroxaban was the most commonly implicated DOAC(n=20,74.1%).The mean time to onset of DILI was 40.6 d.The most common symptoms were jaundice(n=15,55.6%),malaise(n=9,33.3%),and vomiting(n=9,33.3%).Laboratory investigations showed elevated liver enzymes and bilirubin levels.Imaging studies and liver biopsies revealed features of acute hepatitis and cholest

关 键 词：ANTICOAGULANTS Direct-acting oral anticoagulants Drug induced liver injury Drug reactions HEPATOTOXICITY Novel oral anticoagulants 

分 类 号：R575[医药卫生—消化系统]