Outcome of Budd-Chiari Syndrome Patients Treated With Direct Oral Anticoagulants: An Austrian Multicenter Study

作者：Georg Semmler, Alexander Lindorfer, B Schäfer, Stefan Bartl, Stephanie Hametner-Schreil, Sophie Gensluckner, Lorenz Balcar, Katharina Pomej, Katharina Lampichler, Michael Trauner, Elmar Aigner, Christian Datz, Heinz Zoller, Harald Hofer, R Schöfl, Mattias Mandorfer, Thomas Reiberger, Bernhard Scheiner · 发表于：Clinical Gastroenterology and Hepatology · 年份：2022 · DOI：10.1016/j.cgh.2022.04.024 · 被引用次数：38 · 研究领域：Liver Disease and Transplantation、Pulmonary Hypertension Research and Treatments、Spinal Hematomas and Complications

BACKGROUND AND AIMS: Direct oral anticoagulants (DOACs) may simplify management of Budd-Chiari syndrome (BCS). Here, we report our experience with off-label use of DOACs for anticoagulation in BCS. METHODS: The safety of DOAC vs 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 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, 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, more than one DOAC sequentially: 2) for a median of 24.4 (interquartile range, 5.7-35.1) months. While 72.7% (n = 16 of 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 of 22) of BCS patients were initially treated with DOAC. Complete response (European Association for the Study of the Liver 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 hepatocell...