Category: Federal Forum Posters
Purpose: Patients with cirrhosis needing anticoagulation therapy have historically been prescribed warfarin. Direct oral anticoagulants have several benefits over warfarin including convenience, decreased monitoring, decreased drug and dietary restrictions, and faster onset of action. New retrospective research has concluded that direct oral anticoagulants produce the same or decreased bleeding rates when compared directly to warfarin in patients with cirrhosis. The purpose of this study is to evaluate the safety and efficacy of direct oral anticoagulants compared to warfarin in patients with cirrhosis.
Methods: This study will be submitted to the Institutional Review Board for approval. A retrospective chart review will be conducted in adult patients with cirrhosis taking either apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin. Exclusion criteria include patients prescribed triple anticoagulation therapy and indications other than nonvalvular atrial fibrillation and venous thromboembolism (VTE). The following patient characteristics will be collected: demographic data, etiology of cirrhosis, Child-Turcotte-Pugh score, Model for End-Stage Liver Disease score, atrial fibrillation stroke risk score, use of antiplatelets, nonsteroidal anti-inflammatory drugs, proton pump inhibitors, histamine-2 receptor blockers, presence of esophageal varices, albumin, total bilirubin, creatinine, international normalized ratio, platelets, indication for anticoagulation, and days of anticoagulant therapy. The primary endpoint will be all-cause bleeding and the secondary endpoints will be major bleeding and failed efficacy. Major bleeding will be defined using the International Society on Thrombosis and Haemostasis 2005 definition. Failed efficacy will be a combined endpoint including development of VTE, stroke, and/or myocardial infarction. A list of patients with an International Classification of Disease 9/10 code for cirrhosis will be generated. Patient data will be collected from the Computerized Patient Record System from May 29, 2015, to May 29, 2018 and analyzed using descriptive and inferential statistics.
Results: not applicable
Conclusion: not applicable
Kaitlyn Jones– PGY1 Pharmacy Resident, Michael E. DeBakey VA Medical Center, Houston, TX